Provider Demographics
NPI:1043903859
Name:WHITE, KIERSTEN R
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:R
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 ANGLIANA AVE UNIT 1320
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-3533
Mailing Address - Country:US
Mailing Address - Phone:630-945-1851
Mailing Address - Fax:
Practice Address - Street 1:497 ANGLIANA AVE UNIT 1320
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3533
Practice Address - Country:US
Practice Address - Phone:630-945-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer