Provider Demographics
NPI:1326027913
Name:WHITE, CAROL ANN (DNP, ANPC, RN, GNPC,)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:DNP, ANPC, RN, GNPC,
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:BLINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6439 N CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-8893
Mailing Address - Country:US
Mailing Address - Phone:260-224-6161
Mailing Address - Fax:
Practice Address - Street 1:6439 N CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-8893
Practice Address - Country:US
Practice Address - Phone:260-224-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001032B363LG0600X
IN71001032A363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000283474OtherANTHEM
IN201263600Medicaid
IN200312050AMedicaid
P00016928OtherMEDICARE RAILROAD
P77029Medicare UPIN