Provider Demographics
NPI:1962232926
Name:WHITE, ANTHONY KEEGAN II
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:KEEGAN
Last Name:WHITE
Suffix:II
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 1:3406 MOWREY CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2519
Mailing Address - Country:US
Mailing Address - Phone:901-326-1000
Mailing Address - Fax:
Practice Address - Street 1:534 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-1632
Practice Address - Country:US
Practice Address - Phone:901-448-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach