Provider Demographics
NPI:1184627192
Name:WHITE, KATHY Y (FNP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:Y
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:YVETTE
Other - Last Name:BUTLER WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:1737 BELLEVUE GROVE CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016
Mailing Address - Country:US
Mailing Address - Phone:931-237-2175
Mailing Address - Fax:
Practice Address - Street 1:1955 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-7713
Practice Address - Country:US
Practice Address - Phone:901-515-5800
Practice Address - Fax:901-515-5890
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily