Provider Demographics
NPI:1174074280
Name:WHITE, STEPHANY MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 FOLLY BEACH DR APT A
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-3077
Mailing Address - Country:US
Mailing Address - Phone:214-897-0476
Mailing Address - Fax:
Practice Address - Street 1:2701 OSLER DR STE 2
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8386
Practice Address - Country:US
Practice Address - Phone:972-639-3992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752624216Medicaid