Provider Demographics
NPI:1376819748
Name:WHITE, JANAE HARRIS (FNP)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:HARRIS
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANAE
Other - Middle Name:LEANN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-0245
Mailing Address - Country:US
Mailing Address - Phone:601-573-9584
Mailing Address - Fax:
Practice Address - Street 1:110 N JERRY CLOWER BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-5144
Practice Address - Country:US
Practice Address - Phone:662-746-8962
Practice Address - Fax:662-746-8964
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR882972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily