Provider Demographics
NPI:1417830886
Name:WHITE, PAMELA TRIPP
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:TRIPP
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 WHITEVILLE RD # 3107
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-8388
Mailing Address - Country:US
Mailing Address - Phone:850-693-2100
Mailing Address - Fax:
Practice Address - Street 1:3107 WHITEVILLE RD # 3107
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-8388
Practice Address - Country:US
Practice Address - Phone:850-693-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services