Provider Demographics
NPI:1366472870
Name:WHITE, AVA M (FNP C)
Entity Type:Individual
Prefix:MRS
First Name:AVA
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:MRS
Other - First Name:AVA
Other - Middle Name:M
Other - Last Name:BALKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP C
Mailing Address - Street 1:P.O. BOX 828
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-0828
Mailing Address - Country:US
Mailing Address - Phone:910-997-3733
Mailing Address - Fax:910-997-3707
Practice Address - Street 1:809 SOUTH LONG DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4375
Practice Address - Country:US
Practice Address - Phone:910-997-3733
Practice Address - Fax:910-997-3707
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200319OtherLICENSE
NC7000107Medicaid
MW0119506OtherDEA
MW0119506OtherDEA
S11742Medicare UPIN