Provider Demographics
NPI:1366938649
Name:WHITE, MARY E (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0990
Mailing Address - Country:US
Mailing Address - Phone:859-236-4216
Mailing Address - Fax:859-238-9760
Practice Address - Street 1:105 PONDER CT STE 104
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9050
Practice Address - Country:US
Practice Address - Phone:859-236-4216
Practice Address - Fax:859-238-9760
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2025-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY30412451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100557730Medicaid