Healthcare Provider Details

I. General information

NPI: 1205754561
Provider Name (Legal Business Name): VICKI RENEE CARPENTER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 HILLCREST DR
HATTIESBURG MS
39402-8625
US

IV. Provider business mailing address

PO BOX 1522
HATTIESBURG MS
39403-1522
US

V. Phone/Fax

Practice location:
  • Phone: 601-264-0058
  • Fax:
Mailing address:
  • Phone: 601-264-0058
  • Fax: 601-264-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907607
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: