Provider Demographics
NPI:1891568754
Name:WHITE, KANESHA O (MA)
Entity Type:Individual
Prefix:
First Name:KANESHA
Middle Name:O
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 STAFFORD RUN RD APT 1105
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5649
Mailing Address - Country:US
Mailing Address - Phone:832-777-8423
Mailing Address - Fax:
Practice Address - Street 1:2205 WILLIAMS TRACE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4443
Practice Address - Country:US
Practice Address - Phone:832-777-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker