Provider Demographics
NPI:1235615188
Name:BREAKFIELD, CARISA (LPN, CD, CBE, DEM)
Entity Type:Individual
Prefix:MRS
First Name:CARISA
Middle Name:
Last Name:BREAKFIELD
Suffix:
Gender:F
Credentials:LPN, CD, CBE, DEM
Other - Prefix:MRS
Other - First Name:CARISA
Other - Middle Name:
Other - Last Name:BREAKFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN, CD, CBE, DEM
Mailing Address - Street 1:634 MOUNT CARMEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FOXWORTH
Mailing Address - State:MS
Mailing Address - Zip Code:39483-4020
Mailing Address - Country:US
Mailing Address - Phone:601-341-5835
Mailing Address - Fax:
Practice Address - Street 1:634 MOUNT CARMEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:FOXWORTH
Practice Address - State:MS
Practice Address - Zip Code:39483-4020
Practice Address - Country:US
Practice Address - Phone:601-341-5835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 305S00000X, 385H00000X, 176B00000X
MS335283164W00000X, 374J00000X
LA2018245238175M00000X
MS332149246RP1900X
MS261Q00000X, 282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No175M00000XOther Service ProvidersMidwife, LayGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282J00000XHospitalsReligious Nonmedical Health Care InstitutionGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS335283OtherLPN LICENSE
MS57529OtherMADRIELLA DOULA NETWORK DOULA
MSIMP20H8WFDS5OtherAHA BLS INSTRUCTOR
MS20182452OtherDIRECT ENTRY MIDWIFE