Provider Demographics
NPI:1699385773
Name:WHITE, CARL EVERETT (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:EVERETT
Last Name:WHITE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7638
Mailing Address - Country:US
Mailing Address - Phone:303-916-5044
Mailing Address - Fax:
Practice Address - Street 1:1101 OAKRIDGE DR UNIT B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5536
Practice Address - Country:US
Practice Address - Phone:970-223-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995556-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily