Provider Demographics
NPI:1063818359
Name:WHITE, KATHARINE BIRD (PMHCNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:BIRD
Last Name:WHITE
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3822
Mailing Address - Country:US
Mailing Address - Phone:401-615-8775
Mailing Address - Fax:401-615-8776
Practice Address - Street 1:247 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3822
Practice Address - Country:US
Practice Address - Phone:401-615-8775
Practice Address - Fax:401-615-8776
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN18763364SP0808X, 364SP0809X
RIAPRN00003364SP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health