Healthcare Provider Details

I. General information

NPI: 1679934624
Provider Name (Legal Business Name): CARMEN CARR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 RIVERVIEW DR STE A
FLOWOOD MS
39232-8908
US

IV. Provider business mailing address

102 RIVERVIEW DR STE A
FLOWOOD MS
39232-8908
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-1610
  • Fax: 601-366-2887
Mailing address:
  • Phone: 601-981-1610
  • Fax: 601-366-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901441
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: