Provider Demographics
NPI:1366440091
Name:WHITE, LAURA KELLY (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KELLY
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 OLD EKRON RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1735
Mailing Address - Country:US
Mailing Address - Phone:270-422-2200
Mailing Address - Fax:270-422-2221
Practice Address - Street 1:1065 OLD EKRON RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1735
Practice Address - Country:US
Practice Address - Phone:270-422-2200
Practice Address - Fax:270-422-2221
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002841363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004108Medicaid
KY000000305963OtherANTHEM
KY000000861403OtherANTHEM-NSS
KY2444403000OtherPASSPORT ADVANTAGE
KY50064974OtherPASSPORT-NSS
KY50002937OtherPASSPORT
KY158653OtherSIHO-NSS
KY158653OtherSIHO-NSS
KY000000861403OtherANTHEM-NSS
KYP08114Medicare UPIN
KY2444403000OtherPASSPORT ADVANTAGE
IN200468320Medicaid
KY0097190Medicare PIN