Kourtney Elizabeth White, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PT912 Issued in WY

Practice address

700 E Center St
Douglas, WY 82633-2446

Phone

(307) 358-7359

NPI assigned

Jan 4, 2021

Last updated

Jan 4, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Memorial Medical Group LLCGroup PAC ID 1254876683, 40 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital of Converse County Hospital, Douglas, WY, CCN 531302

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Summit Memorial Medical Group LLC

  • General Practice Physician
  • Casper, WY
  • NPI 1598469462
  Medicare reassignment Care Compare group
• Memorial Hospital of Converse County

  • General Practice Physician
  • Douglas, WY
  • NPI 1356496491
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Hospital of Converse County

  • Critical Access Hospital
  • Douglas, WY
  • NPI 1326085408
  Care Compare affiliation

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1184212441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E CENTER ST",
            "city": "DOUGLAS",
            "state": "WY",
            "postal_code": "826332446",
            "telephone_number": "307-358-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E CENTER ST",
            "city": "DOUGLAS",
            "state": "WY",
            "postal_code": "826332446",
            "telephone_number": "307-358-7359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6500 E 2nd St",
            "address_purpose": "LOCATION",
            "city": "Casper",
            "state": "WY",
            "postal_code": "826094338",
            "country_code": "US",
            "telephone_number": "307-577-5100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITE",
        "first_name": "KOURTNEY",
        "middle_name": "ELIZABETH",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-04",
        "last_updated": "2021-01-04",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WY",
            "license": "PT912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwhite@mhccwyo.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "700 E Center St",
            "city": "Douglas",
            "state": "WY",
            "country_code": "US",
            "postal_code": "826332446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Valeria Marie Vrooman, CMT
• Jenna Walker, ATC, L.A.T.
• Kerri Michel Watkins
• Cody Alan Watson
• Tamra Lynn Weber
• William Leslie White, M.D.
• Samantha Wiederrecht, MS, LPC, NCC
• Angela M Wilde, PHARMD
• Kari Williams, RN
• Samuel J Williams

• Medical Physician Assistant in Douglas, WY
• Providers in Douglas, WY by specialty
• Medical Physician Assistant in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.