Healthcare Provider Details

I. General information

NPI: 1922933365
Provider Name (Legal Business Name): CASSIDY CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 OFFICE PARK DR STE A
OXFORD MS
38655-3597
US

IV. Provider business mailing address

409 WOODLAND DR
NEW ALBANY MS
38652-4624
US

V. Phone/Fax

Practice location:
  • Phone: 662-510-8606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908500
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: