Provider Demographics
NPI:1033204383
Name:WHITE, JOLYNN M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOLYNN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:MS
Mailing Address - Zip Code:39192-0246
Mailing Address - Country:US
Mailing Address - Phone:662-967-2015
Mailing Address - Fax:
Practice Address - Street 1:239 BOWLING GREEN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-5167
Practice Address - Country:US
Practice Address - Phone:662-834-1321
Practice Address - Fax:662-834-2111
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR824084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS500007683OtherRAILROAD MEDICARE
MS0118508Medicaid
MS273053YPPXMedicare PIN
MS273053YKDBMedicare PIN
MS500007683OtherRAILROAD MEDICARE