Provider Demographics
NPI:1245777044
Name:WHITE, AUDREY ROWEN (PA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ROWEN
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:L
Other - Last Name:ROWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 HOSPITAL DR
Mailing Address - Street 2:STE 120
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3261
Mailing Address - Country:US
Mailing Address - Phone:843-849-8418
Mailing Address - Fax:843-849-8419
Practice Address - Street 1:1300 HOSPITAL DR
Practice Address - Street 2:STE 120
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3261
Practice Address - Country:US
Practice Address - Phone:843-849-8418
Practice Address - Fax:843-849-8419
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2662363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical