Provider Demographics
NPI:1245681998
Name:WHITE, KIMBERLY MARIE ROE (MD, MS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE ROE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3262 SALT CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-4761
Mailing Address - Country:US
Mailing Address - Phone:402-327-6054
Mailing Address - Fax:
Practice Address - Street 1:3262 SALT CREEK CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-4761
Practice Address - Country:US
Practice Address - Phone:402-327-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE32398208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty