Provider Demographics
NPI:1932855475
Name:WHITE, TERESA MICHELLE (NP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MICHELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MERCY WAY STE 530
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:559-904-1786
Mailing Address - Fax:417-556-3837
Practice Address - Street 1:100 MERCY WAY STE 530
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:559-904-1786
Practice Address - Fax:417-556-3837
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021049922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily