Individual
VALARIE WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1305 N 7TH AVE, LAUREL, MS 39440-2201
(601) 498-0880
Mailing address
1305 N 7TH AVE, LAUREL, MS 39440-2201
(601) 498-0890
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
802084420
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NON
THERES NOT ANY
MS
Enumeration date
08/28/2019
Last updated
07/21/2022
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