Basic Information
| Provider Information | |||||||||
| NPI: | 1033559174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | O'NEAL | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8425 HIGHWAY 17 | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712955424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183812397 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | DELHI | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712323001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188786650 | ||||||||
| FaxNumber: | 3188782880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2013 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP.07482 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | AP07482 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2348337 | 05 | LA | MEDICAID | 13944619 | 01 | CAQH | OTHER | F06131093 | 01 | CERTIFICATION | OTHER |