Provider Demographics
NPI:1144339318
Name:TAYLOR-WHITE, CARLOTTA (RN MSN APN BC)
Entity type:Individual
Prefix:
First Name:CARLOTTA
Middle Name:
Last Name:TAYLOR-WHITE
Suffix:
Gender:F
Credentials:RN MSN APN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-3434
Mailing Address - Fax:314-996-3433
Practice Address - Street 1:969 N MASON RD
Practice Address - Street 2:STE 160
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6338
Practice Address - Country:US
Practice Address - Phone:314-996-3434
Practice Address - Fax:314-996-3433
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO126962163WG0000X, 363LA2200X
IL041-069988163WG0000X
IL209-003181363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ60758Medicare UPIN
ILK24362Medicare PIN
MO828612451Medicare PIN