Provider Demographics
NPI:1851065817
Name:WHITE, KEIRRA JOHNSON (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KEIRRA
Middle Name:JOHNSON
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 WOODDALE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1443
Mailing Address - Country:US
Mailing Address - Phone:225-401-0136
Mailing Address - Fax:
Practice Address - Street 1:3423 NW EVANGELINE TRWY
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-6241
Practice Address - Country:US
Practice Address - Phone:337-245-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221499363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health