Provider Demographics
NPI:1770526782
Name:WHITE, RICKIE LEIGH (CRNA)
Entity type:Individual
Prefix:
First Name:RICKIE
Middle Name:LEIGH
Last Name:WHITE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 IMPERIAL BLVD
Mailing Address - Street 2:BOX 2617
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37077-3211
Mailing Address - Country:US
Mailing Address - Phone:615-838-1402
Mailing Address - Fax:
Practice Address - Street 1:105 IMPERIAL BLVD
Practice Address - Street 2:BOX 2617
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37077-3211
Practice Address - Country:US
Practice Address - Phone:615-838-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN10093367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN430061614OtherRAILROAD MEDICARE
KY74003138OtherKY MEDICAID
TN3629596Medicaid
TN4005023OtherBCBS
TN3629596Medicaid