Provider Demographics
NPI:1134514870
Name:WHITE, MYRA KIM (ARNP-CNM)
Entity type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:KIM
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 MAIN ST
Mailing Address - Street 2:SUITE H1300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2331
Mailing Address - Country:US
Mailing Address - Phone:713-797-1144
Mailing Address - Fax:832-825-7776
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:SUITE H1300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2331
Practice Address - Country:US
Practice Address - Phone:713-797-1144
Practice Address - Fax:832-825-7776
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9371525367A00000X
TX1049133367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9371525OtherSTATE LICENSE
FL015724500Medicaid
FLIG025ZMedicare PIN