Provider Demographics
NPI:1740438399
Name:CARROLL, SCOTT STEWART (CRNA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:STEWART
Last Name:CARROLL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SCENIC MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-8034
Mailing Address - Country:US
Mailing Address - Phone:601-569-4818
Mailing Address - Fax:
Practice Address - Street 1:33 SCENIC MEADOW DR
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-8034
Practice Address - Country:US
Practice Address - Phone:601-569-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR780135367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02277260Medicaid
MS02277260Medicaid