Provider Demographics
NPI:1982634085
Name:WHITE, MISTY M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:VA
Mailing Address - Zip Code:23128-0458
Mailing Address - Country:US
Mailing Address - Phone:757-220-8579
Mailing Address - Fax:757-220-0686
Practice Address - Street 1:329 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6337
Practice Address - Country:US
Practice Address - Phone:757-220-8579
Practice Address - Fax:757-220-0686
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541374556OtherCHAMPUS
VA41212NOtherSENTARA
VA142097OtherANTHEM
1982634085OtherMEDICARE NPI
NJ142097OtherBLUE CROSS
VA541374556OtherCIGNA
VA7781237Medicaid