Provider Demographics
NPI:1407992233
Name:WHITE, KATHERINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 COLLEGE DR
Mailing Address - Street 2:#5066
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39406
Mailing Address - Country:US
Mailing Address - Phone:601-266-5390
Mailing Address - Fax:601-266-4205
Practice Address - Street 1:118 COLLEGE DR
Practice Address - Street 2:#5066
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39406
Practice Address - Country:US
Practice Address - Phone:601-266-5390
Practice Address - Fax:601-266-4205
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR672254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner