Provider Demographics
NPI:1538307897
Name:WHITE, JUSTIN RICHARD (DNP,CNP,PMHNP,LCSW)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RICHARD
Last Name:WHITE
Suffix:
Gender:M
Credentials:DNP,CNP,PMHNP,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4300 RIDGECREST DR SE
Mailing Address - Street 2:STE L #910
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5912
Mailing Address - Country:US
Mailing Address - Phone:505-288-3173
Mailing Address - Fax:505-288-3172
Practice Address - Street 1:4300 RIDGECREST DR SE
Practice Address - Street 2:STE L #910
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5912
Practice Address - Country:US
Practice Address - Phone:505-288-3173
Practice Address - Fax:505-288-3172
Is Sole Proprietor?:No
Enumeration Date:2009-01-25
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMI-075791041C0700X
NMRN-71946163W00000X
CA95012483363LP0808X
AZAP4713363LP0808X
NMCNP-01985363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse