Provider Demographics
NPI:1215519285
Name:WHITE, JOANNA KARMEISHA SR
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:KARMEISHA
Last Name:WHITE
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 S COMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-1906
Mailing Address - Country:US
Mailing Address - Phone:314-845-4508
Mailing Address - Fax:
Practice Address - Street 1:5402 S COMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-1906
Practice Address - Country:US
Practice Address - Phone:314-845-4508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR208252012372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion