Individual provider Active NPI

Tisha Diane White, LVN

  • Licensed Vocational Nurse
  • Odessa, TX
National Provider Identifier
1578063145
Registry record updated Feb 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
201709 Issued in TX
Practice address
11049 W Hoffman Dr
Odessa, TX 79764-9043
Phone
(432) 385-7790
NPI assigned
Feb 20, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X 201709 TX Primary

Addresses

Primary practice location

11049 W Hoffman Dr
Odessa, TX 79764-9043

Mailing address

1917 Morgan Way
Midland, TX 79705-7833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
201709TXMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519084800000",
    "number": "1578063145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1917 MORGAN WAY",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797057833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11049 W HOFFMAN DR",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797649043",
            "telephone_number": "432-385-7790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "TISHA",
        "middle_name": "DIANE",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-20",
        "last_updated": "2018-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "TX",
            "license": "201709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.