Provider Demographics
NPI:1235415860
Name:WHITE, CARRIE ANN (PA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:KNOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2890 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6931
Mailing Address - Country:US
Mailing Address - Phone:989-593-4111
Mailing Address - Fax:989-773-6267
Practice Address - Street 1:2890 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-6931
Practice Address - Country:US
Practice Address - Phone:989-593-4111
Practice Address - Fax:989-773-6267
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006164363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant