Individual
JIMMY A WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3217 MABEL ST, SHREVEPORT, LA 71103-4022
(318) 631-9121
(318) 631-9126
Mailing address
PO BOX 37046, SHREVEPORT, LA 71133-7046
(318) 631-9121
(318) 631-9126
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APO4661
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1624250
—
LA
Enumeration date
05/16/2006
Last updated
03/29/2010
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