Provider Demographics
NPI:1053515296
Name:WHITE, KATHRYN EVELYN (FSP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:EVELYN
Last Name:WHITE
Suffix:
Gender:F
Credentials:FSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N CHOCTAW AVE
Mailing Address - Street 2:SUITE #140
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2624
Mailing Address - Country:US
Mailing Address - Phone:405-262-3209
Mailing Address - Fax:405-262-1331
Practice Address - Street 1:200 N CHOCTAW AVE
Practice Address - Street 2:SUITE #140
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2624
Practice Address - Country:US
Practice Address - Phone:405-262-3209
Practice Address - Fax:405-262-1331
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator