Provider Demographics
NPI:1972936250
Name:WHITE, JECIKA CHEVONNE-ESTELLE (PNP)
Entity Type:Individual
Prefix:
First Name:JECIKA
Middle Name:CHEVONNE-ESTELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MISS
Other - First Name:JECIKA
Other - Middle Name:CHEVONNE-ESTELLE
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:3072 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-5050
Mailing Address - Country:US
Mailing Address - Phone:216-543-2750
Mailing Address - Fax:
Practice Address - Street 1:3072 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-5050
Practice Address - Country:US
Practice Address - Phone:216-543-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH384514163W00000X
OH20153004363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse