Provider Demographics
NPI:1184668584
Name:WHITE, ELIZABETH (ANP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-296-2780
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:5909 U S HIGHWAY 49
Practice Address - Street 2:SUITE 30
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2860
Practice Address - Country:US
Practice Address - Phone:601-296-2780
Practice Address - Fax:601-296-2781
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871182363L00000X
MS871182363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06986397Medicaid
MSQ59983Medicare UPIN
MS500002050Medicare Oscar/Certification
MS500002050Medicare Oscar/Certification