Individual
MRS. BEVERLY DENE WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
600 MAIN ST., OLTON, TX 79064-0508
(806) 285-2209
(806) 285-2209
Mailing address
PO BOX 508, 600 MAIN STREET, OLTON, TX 79064-0508
(806) 292-2754
(806) 285-2175
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00190
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1032277
NCCPA
—
01
—
8N4306
BCBS
TX
01
—
PA00190
PHYSICIAN ASSISTANT LICEN
TX
Enumeration date
08/10/2005
Last updated
02/08/2016
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