Provider Demographics
NPI:1922413954
Name:WHITE, MARY ANN ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2400 HOSPITAL DR.
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2387
Mailing Address - Country:US
Mailing Address - Phone:318-212-7430
Mailing Address - Fax:318-212-7435
Practice Address - Street 1:2400 HOSPITAL DR.
Practice Address - Street 2:SUITE 310
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2387
Practice Address - Country:US
Practice Address - Phone:318-212-7430
Practice Address - Fax:318-212-7435
Is Sole Proprietor?:No
Enumeration Date:2014-06-28
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2376713Medicaid
LA374635YWBOMedicare PIN