Provider Demographics
NPI:1265849525
Name:WHITE, RENNATTA KIPER
Entity Type:Individual
Prefix:
First Name:RENNATTA
Middle Name:KIPER
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1479
Mailing Address - Country:US
Mailing Address - Phone:270-242-2000
Mailing Address - Fax:270-242-2100
Practice Address - Street 1:9847 ELIZABETHTOWN RD
Practice Address - Street 2:
Practice Address - City:BIG CLIFTY
Practice Address - State:KY
Practice Address - Zip Code:42712-5880
Practice Address - Country:US
Practice Address - Phone:270-242-2000
Practice Address - Fax:270-242-2100
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008786363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100303220Medicaid
KYK151672Medicare PIN
KYK151671Medicare PIN