Provider Demographics
NPI:1972526473
Name:WHITE, KATHY LYNN (APRN-C)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CENTERVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4639
Mailing Address - Country:US
Mailing Address - Phone:850-878-8121
Mailing Address - Fax:850-942-6515
Practice Address - Street 1:1401 CENTERVILLE RD STE 600
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-878-8121
Practice Address - Fax:850-942-6515
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1847732363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY011ROtherBCBS OF FLORIDA
FLY011ROtherBCBS OF FLORIDA
FLY011ROtherBCBS OF FLORIDA