Provider Demographics
NPI:1790249225
Name:WHITE, JOSHUA PHILLIP (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:PHILLIP
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 1:8383 MILLICENT WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-5207
Mailing Address - Country:US
Mailing Address - Phone:318-797-6661
Mailing Address - Fax:318-795-8513
Practice Address - Street 1:653 W 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2949
Practice Address - Country:US
Practice Address - Phone:318-636-8389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine