Individual
CRESTYN SLADE WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
806 WASENA AVE SW APT 326, ROANOKE, VA 24015-5358
(304) 413-3597
Mailing address
20 HALL VALLEY CT, BRIDGEPORT, WV 26330-9606
(304) 413-3597
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2710
WV
Other
Enumeration date
06/30/2022
Last updated
06/08/2023
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