Provider Demographics
NPI:1699138776
Name:WHITE, MICHELLE T (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:EAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1535
Mailing Address - Country:US
Mailing Address - Phone:785-354-6773
Mailing Address - Fax:
Practice Address - Street 1:1414 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1535
Practice Address - Country:US
Practice Address - Phone:785-354-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77244363L00000X
KS77244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201137100AMedicaid
KS068002398OtherMEDICARE PTAN