Provider Demographics
NPI:1538304266
Name:WHITE, KELLI RENEE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 PINE ST 504
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2452
Mailing Address - Country:US
Mailing Address - Phone:325-670-4730
Mailing Address - Fax:
Practice Address - Street 1:1924 PINE ST
Practice Address - Street 2:SUITE 401C
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2451
Practice Address - Country:US
Practice Address - Phone:325-670-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX718636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily