Provider Demographics
NPI:1427568260
Name:WHITE, MIRANDA D (APRN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 KERI CV
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-5049
Mailing Address - Country:US
Mailing Address - Phone:901-832-6805
Mailing Address - Fax:
Practice Address - Street 1:6027 WALNUT GROVE RD STE 114
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2115
Practice Address - Country:US
Practice Address - Phone:901-747-1000
Practice Address - Fax:901-747-1001
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN23097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner