Provider Demographics
NPI:1518968148
Name:WHITE, CONNIE GAYLE (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:GAYLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MEDICAL HEIGHTS DR
Mailing Address - Street 2:STE D
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4137
Mailing Address - Country:US
Mailing Address - Phone:502-875-2468
Mailing Address - Fax:502-875-2485
Practice Address - Street 1:101 MEDICAL HEIGHTS DR
Practice Address - Street 2:STE D
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4137
Practice Address - Country:US
Practice Address - Phone:502-875-2468
Practice Address - Fax:502-875-2485
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24085207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000049755OtherBLUE ACCESS BLUE PREFERRE
KY64240856Medicaid
0700222OtherUNITED HEALTH CARE
0700222OtherUNITED HEALTH CARE
1489601Medicare ID - Type Unspecified