Provider Demographics
NPI:1679673735
Name:WHITE, SAUNDRA H (APRN)
Entity Type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:H
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 SLICKBACK RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-7629
Mailing Address - Country:US
Mailing Address - Phone:270-527-1496
Mailing Address - Fax:270-527-5321
Practice Address - Street 1:267 SLICKBACK RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7629
Practice Address - Country:US
Practice Address - Phone:270-527-1496
Practice Address - Fax:270-527-5321
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2963P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20079018Medicaid
KY11479929OtherCAQH
KY2963POtherSTATE LICENSE
KY11479929OtherCAQH
KY2963POtherSTATE LICENSE