Provider Demographics
NPI:1275922189
Name:WHITE, WYNDIE WATSON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:WYNDIE
Middle Name:WATSON
Last Name:WHITE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10939 AL HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1900
Mailing Address - Country:US
Mailing Address - Phone:256-974-3390
Mailing Address - Fax:
Practice Address - Street 1:10939 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1900
Practice Address - Country:US
Practice Address - Phone:256-974-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily