Provider Demographics
NPI:1659059798
Name:MCALLISTER, CARLENE (FNP)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3462 CLEPSYDA DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-6687
Mailing Address - Country:US
Mailing Address - Phone:901-417-9087
Mailing Address - Fax:
Practice Address - Street 1:3462 CLEPSYDA DR
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-6687
Practice Address - Country:US
Practice Address - Phone:901-417-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily