Provider Demographics
NPI:1972166650
Name:WHITE, KATRINA EBONY (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:EBONY
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4960 SAINT CLAUDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-4258
Mailing Address - Country:US
Mailing Address - Phone:504-533-4999
Mailing Address - Fax:504-301-1554
Practice Address - Street 1:1616 FATS DOMINO AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-2950
Practice Address - Country:US
Practice Address - Phone:504-533-4999
Practice Address - Fax:504-301-1554
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA333784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine