Provider Demographics
NPI:1902559479
Name:WHITE, REBECCA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2604
Mailing Address - Country:US
Mailing Address - Phone:816-390-4084
Mailing Address - Fax:
Practice Address - Street 1:724 N 22ND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2604
Practice Address - Country:US
Practice Address - Phone:816-390-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009017595163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health