Provider Demographics
NPI:1760122519
Name:WHITE, KRISTIE LYNN
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LYNN
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEART
Mailing Address - State:ND
Mailing Address - Zip Code:58655-0096
Mailing Address - Country:US
Mailing Address - Phone:701-609-0310
Mailing Address - Fax:
Practice Address - Street 1:605 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:SOUTH HEART
Practice Address - State:ND
Practice Address - Zip Code:58655
Practice Address - Country:US
Practice Address - Phone:701-609-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MUR8540133747P1801X
NDMUR8540133747P1801X
NDMUR8540143747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant