Provider Demographics
NPI:1598724353
Name:WHITE, BETH A (CFNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 15TH ST
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-691-8500
Mailing Address - Fax:304-691-8510
Practice Address - Street 1:1249 15TH ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-691-8500
Practice Address - Fax:304-691-8510
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7105263000Medicaid
KY78011368Medicaid
OH2462820Medicaid
WV7105263000Medicaid
WVNP15023Medicare ID - Type Unspecified