Provider Demographics
NPI:1447296884
Name:WHITE, RHONDA D (NP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 2ND ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5435
Mailing Address - Country:US
Mailing Address - Phone:432-332-5200
Mailing Address - Fax:432-332-5201
Practice Address - Street 1:601 E 2ND ST
Practice Address - Street 2:SUITE G
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5435
Practice Address - Country:US
Practice Address - Phone:432-332-5200
Practice Address - Fax:432-332-5201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N5098OtherBCBS
TX1578283602Medicaid
TX1572836-03Medicaid
TX1578283602Medicaid
TX8B8781Medicare PIN