Provider Demographics
NPI:1568564870
Name:SEARCY, CARISSA IRENE (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:IRENE
Last Name:SEARCY
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:MS
Mailing Address - Zip Code:38876-0122
Mailing Address - Country:US
Mailing Address - Phone:662-652-3361
Mailing Address - Fax:662-652-3363
Practice Address - Street 1:12725 HIGHWAY 23 NORTH
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:MS
Practice Address - Zip Code:38876
Practice Address - Country:US
Practice Address - Phone:662-652-3361
Practice Address - Fax:662-652-3363
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR763745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126874Medicaid
MS500002260OtherMS MEDICARE NO.
P45461Medicare Oscar/Certification
MS500002260Medicare Oscar/Certification
MSP45461Medicare UPIN