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NPI Code Detail

MEDICARE: CARLA JEANETTE ADAMS

MEDICARE: CARLA JEANETTE ADAMS
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363LF0000XFamily Nurse Practitioner905833MS

General Provider Information

NPI Number : 1649992447
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA JEANETTE ADAMS
Provider Business Mailing Address
First Line : 10110 ROAD 2640
Second Line :
City : PHILADELPHIA
State : MS
Zip : 39350-7907
Country : US
Telephone Number : 601-562-8353
Fax Number :
Provider Business Practice Location Address
First Line : 24345 HIGHWAY 15
Second Line :
City : UNION
State : MS
Zip : 39365-8575
Country : US
Telephone Number : 601-774-8211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2022
Last Update Date : 03/30/2023

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Directions to “ CARLA JEANETTE ADAMS ” Practice Location

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