Provider Demographics
NPI:1518744325
Name:WHITE, ALICIA FAE (CPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:FAE
Last Name:WHITE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-0194
Mailing Address - Country:US
Mailing Address - Phone:225-678-0861
Mailing Address - Fax:
Practice Address - Street 1:5354 BLACKMORE RD
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-4201
Practice Address - Country:US
Practice Address - Phone:225-678-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ8C2P4Z4202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology