Provider Demographics
NPI:1033559174
Name:WHITE, JEFFREY O'NEAL (FNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:O'NEAL
Last Name:WHITE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-5424
Mailing Address - Country:US
Mailing Address - Phone:318-381-2397
Mailing Address - Fax:
Practice Address - Street 1:501 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-3001
Practice Address - Country:US
Practice Address - Phone:318-878-6650
Practice Address - Fax:318-878-2880
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP.07482363LF0000X
LAAP07482363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2348337Medicaid
13944619OtherCAQH
F06131093OtherCERTIFICATION