Healthcare Provider Details

I. General information

NPI: 1588393276
Provider Name (Legal Business Name): JERIKIA SADE CARTER MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 WATKINS DR STE B
JACKSON MS
39206-2034
US

IV. Provider business mailing address

PO BOX 103
SUMMIT MS
39666-0103
US

V. Phone/Fax

Practice location:
  • Phone: 601-364-2726
  • Fax: 601-364-2731
Mailing address:
  • Phone: 601-248-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905310
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: