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General NPI Number Information
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NPI Number | 1043638869
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Entity Type | Individual
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Provider Name | WENDELL TYRONE CARNEY NP
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Gender | Male
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 109 E DONALD ST
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City | QUITMAN
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State | MS
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Zip | 39355-2310
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Country | US
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Telephone | 601-513-8508
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Fax | 601-557-4181
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Provider Business Mailing Address
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Address Line | PO BOX 838
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City | QUITMAN
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State | MS
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Zip | 39355-0838
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Country | US
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Telephone | 601-513-8508
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Fax | 601-557-4181
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R862287
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License Number State | MS
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