Provider Demographics
NPI:1790815827
Name:WHITE, JERI A (RN,C)
Entity Type:Individual
Prefix:MS
First Name:JERI
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN,C
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 582
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:AR
Mailing Address - Zip Code:72645-0582
Mailing Address - Country:US
Mailing Address - Phone:870-447-2786
Mailing Address - Fax:
Practice Address - Street 1:316 HWY 65 NORTH
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650
Practice Address - Country:US
Practice Address - Phone:870-448-4727
Practice Address - Fax:870-448-4496
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR43107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse