1033204383 NPI number — MRS. JOLYNN M WHITE FNP

Table of content: MRS. JOLYNN M WHITE FNP (NPI 1033204383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033204383 NPI number — MRS. JOLYNN M WHITE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
JOLYNN
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033204383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39192-0246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-967-2015
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
239 BOWLING GREEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39095-5167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-834-1321
Provider Business Practice Location Address Fax Number:
662-834-2111
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R824084 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500007683 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 0118508 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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