Basic Information
Provider Information
NPI: 1033559174
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITE
FirstName: JEFFREY
MiddleName: O'NEAL
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8425 HIGHWAY 17
Address2:  
City: WINNSBORO
State: LA
PostalCode: 712955424
CountryCode: US
TelephoneNumber: 3183812397
FaxNumber:  
Practice Location
Address1: 107 LELA ST
Address2:  
City: MANGHAM
State: LA
PostalCode: 712595063
CountryCode: US
TelephoneNumber: 3182484100
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/03/2013
LastUpdateDate: 07/03/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XTAP003148LAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home