Provider Demographics
NPI:1346259090
Name:WHITE, CHRISTOPHER BYRON (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BYRON
Last Name:WHITE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 BROECK POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2531
Mailing Address - Country:US
Mailing Address - Phone:502-423-7845
Mailing Address - Fax:
Practice Address - Street 1:1025 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9154
Practice Address - Country:US
Practice Address - Phone:502-222-3886
Practice Address - Fax:502-222-8647
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1058241/1108A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000188228OtherANTHEM BCBS PAR
000000364709OtherANTHEM BCBS PAR
000000188228OtherANTHEM MIDWEST
KY1139310Medicaid
KY74393992Medicaid
000000188228OtherANTHEM BCBS PAR
2438007000Medicare ID - Type UnspecifiedMEDICARE HMO
KY74393992Medicaid
000000364709OtherANTHEM BCBS PAR
IN0964303Medicare ID - Type UnspecifiedMEDICARE INDIANA