Provider Demographics
NPI:1750915989
Name:WHITE, JENNIFER KIM (DNP, NNP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KIM
Last Name:WHITE
Suffix:
Gender:F
Credentials:DNP, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46306 287TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-5080
Mailing Address - Country:US
Mailing Address - Phone:206-799-9945
Mailing Address - Fax:
Practice Address - Street 1:4205 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3665
Practice Address - Country:US
Practice Address - Phone:360-782-7103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60659824163WN0002X
WAAP61339464363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care