Provider Demographics
NPI:1629358056
Name:WHITE, REBECCA JANE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 COGGINS PL NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2585
Mailing Address - Country:US
Mailing Address - Phone:770-422-2009
Mailing Address - Fax:770-428-0330
Practice Address - Street 1:1012 COGGINS PL NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2585
Practice Address - Country:US
Practice Address - Phone:770-422-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118577363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I506780Medicare UPIN