Healthcare Provider Details

I. General information

NPI: 1871313056
Provider Name (Legal Business Name): CAYCEE GARRETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BROOKMAN DR
BROOKHAVEN MS
39601-2326
US

IV. Provider business mailing address

509 BROOKMAN DR
BROOKHAVEN MS
39601-2326
US

V. Phone/Fax

Practice location:
  • Phone: 601-823-5204
  • Fax:
Mailing address:
  • Phone: 601-823-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number907012
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: