Provider Demographics
NPI:1245708569
Name:WHITE, KATE KOSITZKY (C-NP)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:KOSITZKY
Last Name:WHITE
Suffix:
Gender:F
Credentials:C-NP
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:ALEXANDER
Other - Last Name:KOSITZKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-0878
Mailing Address - Country:US
Mailing Address - Phone:678-687-9539
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3050
Practice Address - Country:US
Practice Address - Phone:404-616-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA216058363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty