Provider Demographics
NPI:1063415180
Name:WHITE, KELLY G (PA-C)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:G
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 8255
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-1255
Mailing Address - Country:US
Mailing Address - Phone:318-442-2232
Mailing Address - Fax:318-442-2192
Practice Address - Street 1:605B MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8127
Practice Address - Country:US
Practice Address - Phone:318-442-2232
Practice Address - Fax:318-442-2192
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAPA.A10535207RH0003X
LAA10535363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology