White, Jonathan Tyler

White, Jonathan Tyler is an individual health care provider with primary practice located at 402 Cumberland Ave , Williamsburg KY 40769-1238. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. White, Jonathan Tyler can be contacted via phone (606) 549-2656.

Contact Information

Primary practice address
402 Cumberland Ave Williamsburg KY 40769-1238
Phone: (606) 549-2656
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 5318 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA2916 Kentucky

Profile Details

NPI number 1154998540
LBN Legal business name White, Jonathan Tyler
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 5th, 2021
Last updated May 9th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154998540 NPPES
Tennessee Other 5318 STATE LICENSE
Tennessee Other PA2916 STATE LICENSE
Tennessee MEDICAID 7100770770 STATE LICENSE
Tennessee Other TC120 STATE LICENSE

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