Provider Demographics
NPI:1609650142
Name:WHITE, KARA RAYE
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:RAYE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RAY RD
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-6331
Mailing Address - Country:US
Mailing Address - Phone:229-947-0124
Mailing Address - Fax:
Practice Address - Street 1:301 RAY RD
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-6331
Practice Address - Country:US
Practice Address - Phone:229-947-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant