Provider Demographics
NPI:1770103053
Name:CARTER, HALLIE BRIANNA (PMHNP)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:BRIANNA
Last Name:CARTER
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:BRIANNA
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38870-0305
Mailing Address - Country:US
Mailing Address - Phone:662-651-4637
Mailing Address - Fax:662-651-4636
Practice Address - Street 1:499 GLOSTER CREEK VLG STE D1
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4753
Practice Address - Country:US
Practice Address - Phone:662-690-8007
Practice Address - Fax:662-842-4653
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS900274163W00000X
MS904975363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse