MEDICARE: MRS. SHANE MARIE CARTER FNP-BC

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	907920	MS

General Provider Information

NPI Number	:	1801765250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANE MARIE CARTER FNP-BC

Provider Business Mailing Address
First Line	:	808 VARSITY DR
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-4613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 S GLOSTER ST
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-4934
Country	:	US
Telephone Number	:	662-377-6609
Fax Number	:	662-377-6614

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

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	01/07/2026

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