Provider Demographics
NPI:1750017117
Name:WHITE, KRISTA G (PRSS)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:G
Last Name:WHITE
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-7539
Mailing Address - Country:US
Mailing Address - Phone:304-413-4300
Mailing Address - Fax:
Practice Address - Street 1:206 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-7539
Practice Address - Country:US
Practice Address - Phone:304-413-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20-904175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist