Provider Demographics
NPI:1336572320
Name:CARR, KAYLA LOGAN (RN, FNP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LOGAN
Last Name:CARR
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-6270
Mailing Address - Fax:601-815-1828
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-6270
Practice Address - Fax:601-815-1828
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0082264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0082264OtherFAMILY NURSE PRACTITIONER CERTIFICATION
MS01958808Medicaid
MS0082264OtherFAMILY NURSE PRACTITIONER CERTIFICATION