Individual
KEENON WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9111 ANTIQUE ALY UNIT 1, BRIDGEVILLE, DE 19933-4682
(302) 337-9320
(302) 337-9640
Mailing address
9111 ANTIQUE ALY UNIT 1, BRIDGEVILLE, DE 19933-4682
(302) 337-9320
(302) 337-9640
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
26NP05281400
NJ
207Q00000X
Family Medicine Physician
Primary
C1-0012179
DE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447428636
—
DE
Enumeration date
02/11/2008
Last updated
07/21/2022
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