Healthcare Provider Details

I. General information

NPI: 1609288141
Provider Name (Legal Business Name): NICOLE ELISE CARDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PARKWAY LN STE C
PETAL MS
39465-3035
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-705-0260
  • Fax: 601-261-3583
Mailing address:
  • Phone: 601-705-0260
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25302
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: