Provider Demographics
NPI:1659840536
Name:WHITE, JESSICA NICOLE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 MARGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2666
Mailing Address - Country:US
Mailing Address - Phone:225-276-3492
Mailing Address - Fax:
Practice Address - Street 1:8676 GOODWOOD BLVD STE 402
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7914
Practice Address - Country:US
Practice Address - Phone:225-800-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist