Provider Demographics
NPI:1326479361
Name:WHITE, CAROLINE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
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 1:225 CHAMPAGNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3733
Mailing Address - Country:US
Mailing Address - Phone:931-548-2500
Mailing Address - Fax:
Practice Address - Street 1:1555 GARY DR STE C
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3448
Practice Address - Country:US
Practice Address - Phone:337-909-2460
Practice Address - Fax:337-909-2469
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN166474163WP0218X
LAAP09661363LF0000X
TNAPN0000018068363LF0000X
LA09661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology