Healthcare Provider Details

I. General information

NPI: 1770234338
Provider Name (Legal Business Name): EMILY FOREMAN CARTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY BROOKE FOREMAN

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 W RACE ST
ROLLING FORK MS
39159-2621
US

IV. Provider business mailing address

283 W RACE ST
ROLLING FORK MS
39159-2621
US

V. Phone/Fax

Practice location:
  • Phone: 662-873-0477
  • Fax:
Mailing address:
  • Phone: 662-873-0477
  • Fax: 662-655-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: