Healthcare Provider Details

I. General information

NPI: 1982115945
Provider Name (Legal Business Name): NURSE PRACTITIONER HOUSE CALLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E DONALD ST
QUITMAN MS
39355-2310
US

IV. Provider business mailing address

PO BOX 838
QUITMAN MS
39355-0838
US

V. Phone/Fax

Practice location:
  • Phone: 601-513-8508
  • Fax: 601-557-4181
Mailing address:
  • Phone: 601-513-8508
  • Fax: 601-557-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number862287
License Number StateMS

VIII. Authorized Official

Name: MR. WENDELL T CARNEY
Title or Position: FNP
Credential:
Phone: 601-513-8508