| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JONATHAN TYLER WHITE | 1154998540 | 2021-06-05 |
Jonathan Tyler White is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1154998540. Registration indicates Jonathan Tyler White is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| Entity Type | Individual |
| Provider Name | Mr. Jonathan Tyler White PA |
| Practice Office Address | 402 CUMBERLAND AVE WILLIAMSBURG, KY US |
| Practice Office Telephone | 6065492656 |
| Mailing Address | 107 S MAIN ST JELLICO, TN 377622154 US |
| Business Telephone | 4237848492 |
| Business Fax | 4237848358 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 145 Newcomb Ave | Mount Vernon, KY 404562728 | 6062562195 / 6062562753 |
| 550 Sunset Trl | Jellico, TN 377622343 | 4237845771 |
| 5663 Highway 90 | Clairfield, TN 377153632 | 4237846135 |
| 965 S Highway 25 W | Williamsburg, KY 407691608 | 6065492656 |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | 5318
TN |
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | PA2916
KY |
| 5318 | OTHER | TN | STATE LICENSE |
| PA2916 | OTHER | KY | KY MEDICAL LICE |
| 7100770770 | MEDICAID | KY | |
| TC120 | OTHER | KY | MEDICAL LICENSE |