Provider Demographics
NPI:1275587206
Name:CARTER, TOMIA F (PCNP)
Entity Type:Individual
Prefix:MRS
First Name:TOMIA
Middle Name:F
Last Name:CARTER
Suffix:
Gender:F
Credentials:PCNP
Other - Prefix:MRS
Other - First Name:TOMIA
Other - Middle Name:F
Other - Last Name:BOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCNO
Mailing Address - Street 1:516 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-3559
Mailing Address - Country:US
Mailing Address - Phone:601-342-5901
Mailing Address - Fax:
Practice Address - Street 1:516 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-3559
Practice Address - Country:US
Practice Address - Phone:601-342-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR732001363LP0200X
MS732001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115862Medicaid