Provider Demographics
NPI:1467078790
Name:PORTERFIELD, CARRIE MICHELLE (FNPC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MICHELLE
Last Name:PORTERFIELD
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 CORDER DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6210
Mailing Address - Country:US
Mailing Address - Phone:662-284-9902
Mailing Address - Fax:662-284-9904
Practice Address - Street 1:3050 CORDER DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6210
Practice Address - Country:US
Practice Address - Phone:662-284-9902
Practice Address - Fax:662-284-9904
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty