Basic Information
| Provider Information | |||||||||
| NPI: | 1508866021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 N INDEPENDENCE AVE | ||||||||
| Address2: | 280 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6208452516 | ||||||||
| FaxNumber: | 6208452518 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 S OSAGE ST | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670221650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6208452516 | ||||||||
| FaxNumber: | 6208452518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2005 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R0061883 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 44115 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 100105570A | 05 | OK | MEDICAID | 100351290A | 05 | KS | MEDICAID |