=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760035695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLEY WALKER HERNDON FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2019
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11145 MS-6
-----------------------------------------------------
City | THAXTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-489-8500
-----------------------------------------------------
Fax | 662-489-8600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 499 GLOSTER CREEK VLG STE A1
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-4749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-438-0700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 903408
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------