Healthcare Provider Details

I. General information

NPI: 1447923651
Provider Name (Legal Business Name): CARLEY LAKENN INMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 U S HIGHWAY 98 STE 210
HATTIESBURG MS
39402-8557
US

IV. Provider business mailing address

PO BOX 649113
DALLAS TX
75264-9113
US

V. Phone/Fax

Practice location:
  • Phone: 601-545-7021
  • Fax: 601-545-6978
Mailing address:
  • Phone: 601-545-7021
  • Fax: 601-545-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number00826
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: