Provider Demographics
NPI:1508866021
Name:WHITE, RITA J (ARNP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:620-845-2516
Mailing Address - Fax:620-845-2518
Practice Address - Street 1:415 S OSAGE ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:KS
Practice Address - Zip Code:67022-1650
Practice Address - Country:US
Practice Address - Phone:620-845-2516
Practice Address - Fax:620-845-2518
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0061883363L00000X
KS44115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100105570AMedicaid
KS100351290AMedicaid
OK100105570AMedicaid
OKOK402706Medicare PIN
S63653Medicare UPIN