Provider Demographics
NPI:1659731529
Name:WHITE, MARIAH (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-1637
Mailing Address - Country:US
Mailing Address - Phone:636-916-7060
Mailing Address - Fax:636-916-9421
Practice Address - Street 1:20 PROGRESS POINT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2207
Practice Address - Country:US
Practice Address - Phone:636-916-7060
Practice Address - Fax:636-916-9421
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016006527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant