Individual
PAULA CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5249
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5249
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R859194
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09379223
—
MS
01
—
753068151
MHP
—
01
—
753068151001
TRICARE
MS
Enumeration date
05/29/2007
Last updated
07/21/2022
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