Provider Demographics
NPI:1801980933
Name:WHITE, KATHRYN K (APRN)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:K
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:K
Other - Last Name:ICKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:VERDIGRE
Mailing Address - State:NE
Mailing Address - Zip Code:68783-0099
Mailing Address - Country:US
Mailing Address - Phone:402-668-2216
Mailing Address - Fax:402-668-2310
Practice Address - Street 1:401 JAMES ST
Practice Address - Street 2:
Practice Address - City:VERDIGRE
Practice Address - State:NE
Practice Address - Zip Code:68783-6149
Practice Address - Country:US
Practice Address - Phone:402-668-2216
Practice Address - Fax:402-668-2310
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110334363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37675OtherBCBS OF NE
NE250783OtherMIDLANDS CHOICE
NE250783OtherMIDLANDS CHOICE
NE272577Medicare PIN