Provider Demographics
NPI:1033298773
Name:WHITE, JACQUELINE BARBOUR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:BARBOUR
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:BARBOUR
Other - Last Name:MCCOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2801 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-2998
Mailing Address - Fax:562-933-8080
Practice Address - Street 1:2701 ATLANTIC AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2701
Practice Address - Country:US
Practice Address - Phone:562-933-2998
Practice Address - Fax:562-933-8080
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL263890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA263890OtherPA LICENSE