Provider Demographics
NPI:1295745578
Name:WHITE, LINDA (CRPNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:CRPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5782
Mailing Address - Country:US
Mailing Address - Phone:256-237-1618
Mailing Address - Fax:256-237-2661
Practice Address - Street 1:1001 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5782
Practice Address - Country:US
Practice Address - Phone:256-237-1618
Practice Address - Fax:256-237-2661
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-022510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL202833406OtherALL COMMERCIAL CLAIMS
AK051001495OtherBLUE CROSS BLUE SHIELD
AL8910009700Medicaid
AL202833406OtherTRI CARE