Provider Demographics
NPI:1578150363
Name:WHITE, DAKIN WILL (CRNP)
Entity Type:Individual
Prefix:MR
First Name:DAKIN
Middle Name:WILL
Last Name:WHITE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-1302
Mailing Address - Country:US
Mailing Address - Phone:256-284-7706
Mailing Address - Fax:256-284-7711
Practice Address - Street 1:3500 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1302
Practice Address - Country:US
Practice Address - Phone:256-284-7706
Practice Address - Fax:256-284-7711
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-104605363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL267990Medicaid