Provider Demographics
NPI:1497293328
Name:WHITE, KYLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 E TANGERINE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-6218
Mailing Address - Country:US
Mailing Address - Phone:520-229-2080
Mailing Address - Fax:
Practice Address - Street 1:2530 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2843
Practice Address - Country:US
Practice Address - Phone:520-229-2080
Practice Address - Fax:520-229-2092
Is Sole Proprietor?:No
Enumeration Date:2017-02-12
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ344356Medicaid