Provider Demographics
NPI:1912923962
Name:WHITE, ALEITA ELLEN (MSN NP C)
Entity type:Individual
Prefix:MRS
First Name:ALEITA
Middle Name:ELLEN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSN NP C
Other - Prefix:
Other - First Name:ALEITA
Other - Middle Name:ELLEN
Other - Last Name:KANGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12304 GATLING GUN LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-4811
Mailing Address - Country:US
Mailing Address - Phone:512-292-6832
Mailing Address - Fax:
Practice Address - Street 1:3500 W SLAUGHTER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4421
Practice Address - Country:US
Practice Address - Phone:512-292-6832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0705052363L00000X
TX672321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145078501Medicaid
TX096265604Medicaid
TX8K9771OtherBCBS
TX8726M0Medicare ID - Type Unspecified
TX096265604Medicaid