White-Wilson Medical Center, P.a.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

WHITE-WILSON MEDICAL CENTER, P.A.

Practice address

1045 US Highway 331 S
Defuniak Springs, FL 32435-3379

Phone

(850) 892-3366

Fax

(833) 451-2226

NPI assigned

Apr 22, 2024

Organization subpart

Yes

Parent organization

WHITE-WILSON MEDICAL CENTER, P.A.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth Persaud

Title

Ceo

Phone

(850) 863-8150

Specialties & licenses 1

Addresses

Other names 1

• White-Wilson Medical Center DFK Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

White Wilson Medical Center6 organizations share this tax ID, including this one

Part of

White Wilson Medical Center

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

• White-Wilson Medical Center, P.a.

  • Family Medicine Physician
  • Niceville, FL
  • NPI 1013054469
  NPD tax ID
• White-Wilson Medical Center, P.a.

  • Family Medicine Physician
  • Fort Walton Beach, FL
  • NPI 1134267537
  NPD tax ID
• White-Wilson Medical Center, P.a.

  • Pediatrics Physician
  • Destin, FL
  • NPI 1184761538
  NPD tax ID
• White-Wilson Medical Center, P.a.

  • Pediatrics Physician
  • Niceville, FL
  • NPI 1447474234
  NPD tax ID
• White-Wilson Medical Center, P.a.

  • Pediatrics Physician
  • Fort Walton Beach, FL
  • NPI 1518005917
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Douglas Winston Rigby, M.D.

  • Pediatrics Physician
  • Fort Walton Beach, FL
  • NPI 1265417166
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1063267128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476707",
            "telephone_number": "850-863-8299",
            "fax_number": "850-863-4152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 US HIGHWAY 331 S",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324353379",
            "telephone_number": "850-892-3366",
            "fax_number": "833-451-2226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "127 E Redstone Ave",
            "address_purpose": "LOCATION",
            "city": "Crestview",
            "state": "FL",
            "postal_code": "325395358",
            "country_code": "US",
            "telephone_number": "850-398-8725",
            "fax_number": "833-305-0362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 E Redstone Ave",
            "address_purpose": "LOCATION",
            "city": "Crestview",
            "state": "FL",
            "postal_code": "325395348",
            "country_code": "US",
            "telephone_number": "850-398-8725",
            "fax_number": "888-987-3138",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1332 N Ferdon Blvd",
            "address_purpose": "LOCATION",
            "city": "Crestview",
            "state": "FL",
            "postal_code": "325361749",
            "country_code": "US",
            "telephone_number": "850-634-6193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WHITE-WILSON MEDICAL CENTER, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITE-WILSON MEDICAL CENTER, P.A.",
        "enumeration_date": "2024-04-22",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "PERSAUD",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-863-8150"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White-Wilson Medical Center DFK",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "White-Wilson Medical Center DFK",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amanda L Walton, LMHC
• Trevarius Watson
• Chambleigh Lee Webster, RBT
• Katie Weeks, LCSW
• Regina Dawn Wetmore, LMT FLORIDA
• Jennifer Vital Whitfield, MD
• Sage Lynn Wiederhold
• Stephanie Jean Wiggins, RBT
• Olivia Wilder, HAS
• Bruce Alan Wilkinson

• Rural Health Clinic/Center in Defuniak Springs, FL
• Providers in Defuniak Springs, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.