Individual
STACEY A. CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-0115
(601) 984-5257
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-0115
(601) 984-5257
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
13075
TN
363LF0000X
Family Nurse Practitioner
Primary
R881362
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06826705
—
MS
Enumeration date
02/01/2008
Last updated
06/14/2012
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