Provider Demographics
NPI:1144772153
Name:WHITE, LAURA SULLIVAN (APN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SULLIVAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:7191 CAHABA VALLEY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6461
Mailing Address - Country:US
Mailing Address - Phone:205-405-7575
Mailing Address - Fax:
Practice Address - Street 1:7191 CAHABA VALLEY RD STE 300
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-6461
Practice Address - Country:US
Practice Address - Phone:205-995-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-140447363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026597Medicaid
TN21945OtherAPN LICENSE
TNQ026597Medicaid