Provider Demographics
NPI:1457821860
Name:WHITE, KATRINA BETH (LVN)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:BETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:TX
Mailing Address - Zip Code:75758-8551
Mailing Address - Country:US
Mailing Address - Phone:903-941-1261
Mailing Address - Fax:
Practice Address - Street 1:5213 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:TX
Practice Address - Zip Code:75758-8551
Practice Address - Country:US
Practice Address - Phone:903-941-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153601164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse