Provider Demographics
NPI:1447245568
Name:WHITE, CAROL (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 BESSEMER SUPER HWY
Mailing Address - Street 2:
Mailing Address - City:MIDFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35228-3013
Mailing Address - Country:US
Mailing Address - Phone:205-715-6121
Mailing Address - Fax:
Practice Address - Street 1:631 BESSEMER SUPER HWY
Practice Address - Street 2:
Practice Address - City:MIDFIELD
Practice Address - State:AL
Practice Address - Zip Code:35228
Practice Address - Country:US
Practice Address - Phone:205-715-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2010-033363LW0102X
AL1-058146363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-16836OtherBLUE CROSS BLUE SHIELD OF AL (WESTERN LOCATION)
AL227330000Medicaid
AL227390000Medicaid
AL511-16835OtherBLUE CROSS BLUE SHIELD OF AL. (WEST END LOCATION)