Individual
JALISA WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
612 S 6TH ST, EDWARDSVILLE, KS 66111-1393
(913) 309-9281
Mailing address
612 S 6TH ST, EDWARDSVILLE, KS 66111-1393
(913) 309-9281
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
13-131827-041
KS
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
53-81350-041
KS
Other
Enumeration date
06/21/2022
Last updated
10/31/2022
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