Provider Demographics
NPI:1417327545
Name:WHITE, CRYSTAL M (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LENAPE DR
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-4403
Mailing Address - Country:US
Mailing Address - Phone:918-273-0192
Mailing Address - Fax:620-251-5412
Practice Address - Street 1:1020 LENAPE DR
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-4403
Practice Address - Country:US
Practice Address - Phone:918-273-0192
Practice Address - Fax:918-273-0194
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK91105363L00000X
KS76909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000000000000OtherUNSURE