Individual provider Active NPI

Keena McNease White

  • Family Nurse Practitioner
  • Baxley, GA
National Provider Identifier
1710445374
Registry record updated Mar 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F12170456 Issued in GA
Practice address
437 W Parker St
Baxley, GA 31513-0605
Phone
(912) 705-0858
NPI assigned
Mar 3, 2019
Last updated
Mar 3, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F12170456 GA Primary

Addresses

Primary practice location

437 W Parker St
Baxley, GA 31513-0605

Mailing address

1770 Kecia Way
Waycross, GA 31503-9100
Phone (912) 286-3140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20220622001300 GA Practitioner - Nurse Practitioner 0547649535 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

163 E Tollison St
Baxley, GA 31513-0120
Phone 91236798411259

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F12170456GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Baxley and Appling County Hospital Authority CurrentSince May 2, 2022 Accepting new patients
The Baxley and Appling County Hospital Authority Family CurrentSince May 2, 2022 Accepting new patients
Southern Counseling Services LLC Past Accepting new patients

Locations

163 E Tollison St
Baxley, GA 31513
Phone (912) 367-9847

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1551571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551571200000",
    "number": "1710445374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 KECIA WAY",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315039100",
            "telephone_number": "912-286-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 W PARKER ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130605",
            "telephone_number": "912-705-0858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "KEENA",
        "middle_name": "MCNEASE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-03",
        "last_updated": "2019-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "F12170456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxley, GA

Sources for this page

Verify at the official NPI Registry.