Provider Demographics
NPI:1205026481
Name:WHITE, KATY (NP)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4591
Mailing Address - Country:US
Mailing Address - Phone:707-463-1900
Mailing Address - Fax:707-780-6375
Practice Address - Street 1:115 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4591
Practice Address - Country:US
Practice Address - Phone:707-463-1900
Practice Address - Fax:707-780-6375
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16565363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16565OtherLICENSE