Provider Demographics
NPI:1760035695
Name:HERNDON, CARLEY WALKER (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARLEY
Middle Name:WALKER
Last Name:HERNDON
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 1:11145 MS-6
Mailing Address - Street 2:
Mailing Address - City:THAXTON
Mailing Address - State:MS
Mailing Address - Zip Code:38871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11145 MS-6
Practice Address - Street 2:
Practice Address - City:THAXTON
Practice Address - State:MS
Practice Address - Zip Code:38871
Practice Address - Country:US
Practice Address - Phone:662-489-8500
Practice Address - Fax:662-489-8600
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily