Provider Demographics
NPI:1972846798
Name:WHITE, JESSICA MAY (MD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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:504-503-0299
Practice Address - Street 1:221 W GENIE ST
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-2125
Practice Address - Country:US
Practice Address - Phone:504-533-4999
Practice Address - Fax:504-503-0299
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA303715208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2333402Medicaid
MS00079533Medicaid
LA544887YH3UMedicare PIN