Provider Demographics
NPI:1740413764
Name:NORRIS, CAREY LEIGH (FNP)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:LEIGH
Last Name:NORRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:LEIGH
Other - Last Name:REVELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7100 U S HIGHWAY 98 STE 220
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8557
Mailing Address - Country:US
Mailing Address - Phone:601-582-7655
Mailing Address - Fax:601-450-2441
Practice Address - Street 1:7100 U S HIGHWAY 98 STE 220
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8557
Practice Address - Country:US
Practice Address - Phone:601-582-7655
Practice Address - Fax:601-450-2441
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870159363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9055452OtherAETNA
MS08327830Medicaid
MS302I506421Medicare PIN