Provider Demographics
NPI:1013525153
Name:WHITE, TIMOTHY (HIS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1929
Mailing Address - Country:US
Mailing Address - Phone:304-654-9848
Mailing Address - Fax:
Practice Address - Street 1:121 MALABU DR STE 3
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3143
Practice Address - Country:US
Practice Address - Phone:859-238-0070
Practice Address - Fax:513-332-9072
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2102003029237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist