Provider Demographics
NPI:1295216125
Name:WHITE, HEATHER (MPAS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:101 HARTS LANDING LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3235
Mailing Address - Country:US
Mailing Address - Phone:318-677-9163
Mailing Address - Fax:
Practice Address - Street 1:745 OLIVE ST STE 200
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2246
Practice Address - Country:US
Practice Address - Phone:318-213-2213
Practice Address - Fax:318-213-2215
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant