Provider Demographics
NPI:1679387286
Name:VICTORIA L CARROLL, PMHNP-BC, LLC
Entity type:Organization
Organization Name:VICTORIA L CARROLL, PMHNP-BC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, MSN, APRN
Authorized Official - Phone:901-490-0093
Mailing Address - Street 1:740 AVIGNON DR STE C
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5160
Mailing Address - Country:US
Mailing Address - Phone:601-937-4552
Mailing Address - Fax:
Practice Address - Street 1:740 AVIGNON DR STE C
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5160
Practice Address - Country:US
Practice Address - Phone:601-937-4552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1427501857Medicaid