Provider Demographics
NPI:1942668314
Name:WHITE, KATHLEEN E (MSN FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:E
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:E
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:2111 LEXINGTON AVE
Mailing Address - Street 2:STE #1
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439
Mailing Address - Country:US
Mailing Address - Phone:618-943-7214
Mailing Address - Fax:618-943-7219
Practice Address - Street 1:2111 LEXINGTON AVE
Practice Address - Street 2:STE #1
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439
Practice Address - Country:US
Practice Address - Phone:618-943-7214
Practice Address - Fax:618-943-7219
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily