Jalisa White, NNP
Individual provider Active NPI Critical Care Neonatal Nurse Practitioner · Edwardsville, KS
NPI 1497486567 · NPPES record last updated Oct 31, 2022
Key facts
- NPI
- 1497486567
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Critical Care Neonatal Nurse Practitioner 363LN0005X
- License
- 53-81350-041 (KS)
- Practice address
- 612 S 6TH St
Edwardsville, KS 66111-1393 - Phone
- (913) 309-9281
- NPI assigned
- Jun 21, 2022
- Reactivated
- Oct 11, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221205002348 | KS | Practitioner - Nurse Practitioner | 0648649137 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13-131827-041 | KS | MD | Neonatal Intensive Care Registered Nurse |
| 53-81350-041 | KS | MD | Critical Care Neonatal Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kansas University Physicians Inc | Single Specialty | Current |
Accepting new patients |
| Kansas University Physicians Inc | Single Specialty | Current |
Accepting new patients |
| Kansas University Physicians Inc | Single Specialty | Current | Accepting new patients |
Locations
3901 Rainbow Blvd
Kansas City, KS 66160
Phone (913) 588-6005
4000 Cambridge St
Kansas City, KS 66160
Phone (913) 588-0000
11300 Corporate Ave
Ste 342
Lenexa, KS 66219
Phone (913) 574-0425
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal Intensive Care Registered Nurse |
163WN0002X | 13-131827-041 | KS | |
| Critical Care Neonatal Nurse Practitioner |
363LN0005X | 53-81350-041 | KS | Yes |
Addresses
Primary practice location
612 S 6TH St
Edwardsville, KS 66111-1393
Mailing address
612 S 6TH St
Edwardsville, KS 66111-1393
Phone (913) 309-9281
Other names
- Jalisa Brice
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jacwhitefamily@outlook.com | Direct |
Other providers in Edwardsville, KS
- Parkway Operator, LLC
- Ashley Dawn Roberts
- SJS Ventures, LLC
- Daniel Lewis Strom
- Teresa Reichart-Vernon, Lscsw LLC
All providers in Edwardsville, KS · Critical Care Neonatal Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.