Individual
CARLY O'NEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
2100 E CHAMBERS DR, BOONEVILLE, MS 38829-8938
(662) 286-9883
Mailing address
112 ENGLEWOOD CV, SALTILLO, MS 38866-8725
(662) 397-4574
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
902870
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
902870
PMHNP
MS
Enumeration date
08/28/2018
Last updated
08/28/2018
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