Healthcare Provider Details

I. General information

NPI: 1245601913
Provider Name (Legal Business Name): JENNIFER CARNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 HOSPITAL ST
PASCAGOULA MS
39581-5320
US

IV. Provider business mailing address

6605 SKEETER BRANCH RD
LUCEDALE MS
39452-6922
US

V. Phone/Fax

Practice location:
  • Phone: 228-283-4140
  • Fax:
Mailing address:
  • Phone: 567-213-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: