DR. JERRY WADE WHITE (NPI# 1992775209) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992775209 |
| Entity Type | Individual |
| Full Name | DR. JERRY WADE WHITE |
| Credential | MD |
| Practice Address |
650 Joel Dr Fort Campbell KY 42223-5318 |
| Practice Telephone | 2707984677 |
| Practice Fax Number | 2709560444 |
| Mailing Telephone | 2707984677 |
| Mailing Fax Number | 2709560444 |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2019-07-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
C52893 | CA | Allopathic & Osteopathic Physicians |
| N | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
MD.018896 | LA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295826428 | Jerry A White | Marriage & Family Therapist | 7777 Alvarado Rd Ste 277, La Mesa, CA 91941-3616 | 2006-09-26 |
| 1083722532 | Jerry Don White | Psychologist | 2525 Northwest Expressway, Suite 420, Oklahoma City, OK 73112-7227 | 2006-08-25 |
| 1245655968 | Jerry Ray White II | Internal Medicine | 613 23rd St Ste 230, Ashland, KY 41101-2868 | 2014-03-04 |
| 1336359017 | Jerry Chad White | Family Medicine | 115 E Business Highway 60, Dexter, MO 63841-1000 | 2007-05-23 |
| 1912031964 | Jerry L. White | Psychologist | 409 Coleman Blvd, Suite 1a, Mt Pleasant, SC 29464-4391 | 2007-03-14 |
| 1992769996 | Jerry Lewis White | Anesthesiology | 1 Elliot Way, Suite 200, Manchester, NH 03103-3502 | 2006-04-14 |
| Street Address |
650 JOEL DR |
| City | FORT CAMPBELL |
| State | KY |
| Zip Code | 42223-5318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982601803 | Carol Lynn Pasewark | Counselor | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2005-07-07 |
| 1568063519 | Jeremy Schadewald | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-11-05 |
| 1578164760 | Brandi Mangan | Nurse Practitioner | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-11-04 |
| 1912506692 | Rose Dunn | Optometrist | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-10-22 |
| 1659989440 | Patrick Ogden | Student in an Organized Health Care Education/Training Program | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-17 |
| 1487262408 | John William Zamora | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-15 |
| 1295343218 | Joshua Ryan Agard | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-15 |
| 1902424435 | Shaina Escribano-miranda | Nurse Practitioner | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-10 |
| 1326665514 | Cristal Lagail Trotter | Nurse Anesthetist, Certified Registered | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-03 |
| 1689209728 | William James Bradshaw | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-03-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558978825 | Eden Addisu Kebede | Social Worker | Ft. Campbell/bach, 650 Joel Drive, Fort Campbell, KY 42223 | 2020-09-30 |
| 1174134662 | Lucas Pepper | Dentist | Desert Storm Ave, Bldg 5580, Apo, AA 42223 | 2020-08-10 |
| 1639711203 | Travis Robert Bryant | Optometrist | 5979 Desert Storm Ave., Lapointe Health Clnic Optometry, Ft. Campbell, KY 42223 | 2019-10-15 |
| 1184138232 | Vanessa Renee Simmons | Dental Assistant | 302b Baker St, Fort Campbell, KY 42223 | 2017-11-28 |
| 1922451996 | Isabella Julson | Dental Assistant | Bldg2441 21st Street, Us Army Dental Activity, Fort Campbell, KY 42223 | 2016-07-14 |
| 1336595305 | Heidi Cameron | Acupuncturist | 2889b Idaho Avenue, Fort Campbell, KY 42223 | 2016-05-10 |
| 1649644154 | Nathan Silvey | Physician Assistant | Building 4179, Fort Campbell, KY 42223 | 2015-11-20 |
| 1396145306 | Blanchfield Army Community Hospital | Clinic/Center | Bldg 2403, Air Assault St and Indiana Ave, Fort Campbell, KY 42223 | 2014-08-27 |
| 1275948564 | Rodney C Merkley | Psychologist | Building 3929, Ft. Capmbell, KY 42223 | 2014-06-25 |
| 1659785053 | Blanchfield Army Community Hospital | Clinic/Center | Bldg 6747 A Shau Valley Road, Fort Campbell, KY 42223 | 2014-06-13 |
| Find all providers in zip 42223 | ||||
| Taxonomy Code | 2080P0006X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Developmental – Behavioral Pediatrics |
| A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed, 3/26/2008: definition corrected] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023181815 | Philip J Mattheis | Pediatrics | 10186 Timbercreek Dr, Union, KY 41091-9710 | 2006-11-17 |
| 1942205943 | Kentucky Medical Supply, Inc. | Pediatrics | 102 Castle Ridge Dr, Edmonton, KY 42129 | 2005-06-16 |
| 1356843510 | Dianna Grueser | Pediatrics | 1451 Diederich Blvd, Russell, KY 41169-1718 | 2018-03-05 |
| 1215448287 | Milestones Therapy Center Inc. | Pediatrics | 903 Bellefonte Rd Ste A, Flatwoods, KY 41139-2005 | 2017-10-18 |
| 1265707384 | University of Louisville Research Foundation | Pediatrics | 571 S Floyd St, Suite 100, Louisville, KY 40202-3818 | 2012-03-22 |
| 1033373543 | Maria Romelinda Lazaro Mendoza | Pediatrics | 571 S Floyd St, Suite 130, Louisville, KY 40202-3818 | 2008-07-14 |
| 1649307224 | Monroe Medical Equipment Co LLC | Pediatrics | 801 N Main St, Tompkinsville, KY 42167-1002 | 2007-02-28 |
| 1679549935 | Quentin A Humberd | Pediatrics | 650 Joel Drive, Blanchfield Army Community Hospital, Ft Campbell, KY 42223-5349 | 2006-02-27 |
| 1003894908 | Patricia Gail Williams | Pediatrics | 411 E Chestnut St, Louisville, KY 40202-1713 | 2006-01-03 |
| City | FORT CAMPBELL |
| Zip Code | 42223 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.