Provider Demographics
NPI:1033741665
Name:WHITE, KATHERINE J (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
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 1:8812 W MARIPOSA GRANDE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1204
Mailing Address - Country:US
Mailing Address - Phone:602-299-6366
Mailing Address - Fax:
Practice Address - Street 1:8812 W MARIPOSA GRANDE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1204
Practice Address - Country:US
Practice Address - Phone:602-299-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN138584163WE0003X
AZ251761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Multi-Specialty