Provider Demographics
NPI:1851868376
Name:WHITE, TIANA
Entity Type:Individual
Prefix:MRS
First Name:TIANA
Middle Name:
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 1:312 WHITTINGTON PKWY STE 20
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4925
Mailing Address - Country:US
Mailing Address - Phone:502-429-1249
Mailing Address - Fax:
Practice Address - Street 1:312 WHITTINGTON PKWY STE 20
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4925
Practice Address - Country:US
Practice Address - Phone:502-429-1249
Practice Address - Fax:502-429-1249
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator