Provider Demographics
NPI:1255066965
Name:WHITE, JOSEPHINE (APRN)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:BOSQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 PARK DR APT 637
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7429
Mailing Address - Country:US
Mailing Address - Phone:407-745-1196
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE # 6A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-6827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR094911163W00000X
AR124056363LP0200X
OK208981363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse