Provider Demographics
NPI:1093476798
Name:WHITE, STEPHANIE SUE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUE
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WOODBINE PL
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-2912
Mailing Address - Country:US
Mailing Address - Phone:903-234-4226
Mailing Address - Fax:903-234-1639
Practice Address - Street 1:1500 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-3005
Practice Address - Country:US
Practice Address - Phone:903-938-7721
Practice Address - Fax:903-234-1639
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057169363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health