Individual
CARRIE LEE FERNALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
215 MARION AVE, MCCOMB, MS 39648-2705
(601) 249-5500
Mailing address
1537 MONTICELLO ST NE, BROOKHAVEN, MS 39601-8802
(601) 754-2991
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
904256
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02304077
—
MS
Enumeration date
10/28/2020
Last updated
05/05/2021
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