Individual
JASON GREGORY WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-7737
Mailing address
PO BOX 5310, SHREVEPORT, LA 71135-5310
(318) 675-7737
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN104875
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104875
RN
LA
Enumeration date
04/04/2007
Last updated
10/11/2012
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