Provider Demographics
NPI:1053342352
Name:CARTER, JANELL G (FNP)
Entity type:Individual
Prefix:MS
First Name:JANELL
Middle Name:G
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:RICHTON
Mailing Address - State:MS
Mailing Address - Zip Code:39476-2941
Mailing Address - Country:US
Mailing Address - Phone:601-788-6316
Mailing Address - Fax:601-788-2230
Practice Address - Street 1:206 BAY AVE
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476-2941
Practice Address - Country:US
Practice Address - Phone:601-788-6316
Practice Address - Fax:601-788-2230
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR669474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02154265Medicaid
AL891011540Medicaid
MS02154265Medicaid