Healthcare Provider Details

I. General information

NPI: 1316750045
Provider Name (Legal Business Name): CARRINGTON ALBERNISE SALLIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 AVERY BLVD N
RIDGELAND MS
39157-5219
US

IV. Provider business mailing address

768 AVERY BLVD N
RIDGELAND MS
39157-5219
US

V. Phone/Fax

Practice location:
  • Phone: 601-487-6482
  • Fax:
Mailing address:
  • Phone: 601-487-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number907076
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907076
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: