Provider Demographics
NPI:1265883730
Name:WHITE, LAURA H (PMHNP, FNP-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:WHITE
Suffix:
Gender:F
Credentials:PMHNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:GA
Mailing Address - Zip Code:31002-0394
Mailing Address - Country:US
Mailing Address - Phone:478-278-1723
Mailing Address - Fax:
Practice Address - Street 1:414 LUGENIA DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-7201
Practice Address - Country:US
Practice Address - Phone:912-537-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118676363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily