Healthcare Provider Details

I. General information

NPI: 1164369013
Provider Name (Legal Business Name): BRIDGET LANE CARTER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 WAYNE DR
DIBERVILLE MS
39540-8554
US

IV. Provider business mailing address

922 PORTER AVE APT 211
OCEAN SPRINGS MS
39564-4662
US

V. Phone/Fax

Practice location:
  • Phone: 228-313-3051
  • Fax:
Mailing address:
  • Phone: 228-313-3051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908191
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: