Nicole Marie White, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2008015096 Issued in MO

Practice address

4320 Osage Beach Parkway
Suite a
Osage Beach, MO 65065

Phone

(573) 348-1466

Fax

(573) 348-1581

NPI assigned

Jun 5, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nicole Marie Kempker Former name

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1407015456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 OSAGE BEACH PARKWAY",
            "address_2": "SUITE A",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "65065",
            "telephone_number": "573-348-1466",
            "fax_number": "573-348-1581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 OSAGE BEACH PARKWAY",
            "address_2": "SUITE A",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "65065",
            "telephone_number": "573-348-1466",
            "fax_number": "573-348-1581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-05",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2008015096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407015456",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "KEMPKER",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charles Welch, CRNA
• Theresa Welch, LCSW
• Well Aligned Chiropractic, LLC
• Ryan Wetzel, PHARMD
• Jacob Andrew White, PA-C
• Hallie Jean Willis, FNP-C
• Jessica Willis
• Cori Ann Wilson, P.T.A.
• Douglas Glen Wilson, D.O.
• Women'S Functional Health and Hormone Ce

• General Practice Dentistry in Osage Beach, MO
• Providers in Osage Beach, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.