Healthcare Provider Details

I. General information

NPI: 1235615188
Provider Name (Legal Business Name): CARISA BREAKFIELD CPM, LM, DSM, DNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARISA BREAKFIELD CPM, LM, DSM, DNM

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S LEA AVE
ROSWELL NM
88203-4564
US

IV. Provider business mailing address

634 MOUNT CARMEL CHURCH RD
FOXWORTH MS
39483-4020
US

V. Phone/Fax

Practice location:
  • Phone: 601-341-5835
  • Fax:
Mailing address:
  • Phone: 601-341-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number335283
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number341549
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number332149
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number24003R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: