Individual
MISS CLARICE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
R525359
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08103071
UP MEDICAID GROUP NUMBER
MS
05
—
09986883
—
MS
Enumeration date
09/15/2006
Last updated
03/03/2008
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