Provider Demographics
NPI:1740876747
Name:WHITE, KRISTI KAY
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:KAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:KAY
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:502 S KINGSWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1732
Mailing Address - Country:US
Mailing Address - Phone:810-493-4583
Mailing Address - Fax:
Practice Address - Street 1:502 S KINGSWOOD ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1732
Practice Address - Country:US
Practice Address - Phone:810-493-4583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230208221098376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide