Provider Demographics
NPI:1891149753
Name:BIRDWELL-WHITE, JAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:BIRDWELL-WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LEIGH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1534 LATIGO LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-6589
Mailing Address - Country:US
Mailing Address - Phone:214-536-8670
Mailing Address - Fax:
Practice Address - Street 1:1534 LATIGO LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-6589
Practice Address - Country:US
Practice Address - Phone:214-536-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09273363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical