Provider Demographics
NPI:1013580505
Name:CARTER, CASSI (RN, FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:CASSI
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 WILKINS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DUCK HILL
Mailing Address - State:MS
Mailing Address - Zip Code:38925-9715
Mailing Address - Country:US
Mailing Address - Phone:662-473-6011
Mailing Address - Fax:
Practice Address - Street 1:1850 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3404
Practice Address - Country:US
Practice Address - Phone:601-376-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904769363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner