Provider Demographics
NPI:1871898189
Name:WHITE, JENNIFER L (ACNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5470 KINGS ISLAND DRIVE
Mailing Address - Street 2:STE 120
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2796
Mailing Address - Country:US
Mailing Address - Phone:513-791-4490
Mailing Address - Fax:513-978-5050
Practice Address - Street 1:5470 KINGS ISLAND DRIVE
Practice Address - Street 2:STE 120
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2796
Practice Address - Country:US
Practice Address - Phone:513-791-4490
Practice Address - Fax:513-978-5050
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN304559163W00000X
OHCOA.12160-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3142772Medicaid
IN201042820Medicaid
KY7100185390Medicaid
OH3142772Medicaid