Basic Information
| Provider Information | |||||||||
| NPI: | 1194935171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 502 | ||||||||
| Address2: | |||||||||
| City: | BRYANT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720890502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013178012 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20400 COLONEL GLENN RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722105323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018215500 | ||||||||
| FaxNumber: | 5018217062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R49436 | AR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.