MEDICARE: JERIKIA SADE CARTER MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	905310	MS

General Provider Information

NPI Number	:	1588393276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERIKIA SADE CARTER MSN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 103
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-0103
Country	:	US
Telephone Number	:	601-248-2009
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 WATKINS DR STE B
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-2034
Country	:	US
Telephone Number	:	601-364-2726
Fax Number	:	601-364-2731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	06/07/2022

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