1588393276 NPI number — JERIKIA SADE CARTER MSN, FNP-C

Table of content: JERIKIA SADE CARTER MSN, FNP-C (NPI 1588393276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588393276 NPI number — JERIKIA SADE CARTER MSN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
JERIKIA
Provider Middle Name:
SADE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588393276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMIT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39666-0103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-248-2009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5440 WATKINS DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39206-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-364-2726
Provider Business Practice Location Address Fax Number:
601-364-2731
Provider Enumeration Date:
06/07/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  905310 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com