Provider Demographics
NPI:1811963127
Name:ESTES, CAROLYN (NP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ESTES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4905
Mailing Address - Country:US
Mailing Address - Phone:662-377-7150
Mailing Address - Fax:662-377-7155
Practice Address - Street 1:860 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4905
Practice Address - Country:US
Practice Address - Phone:662-377-7150
Practice Address - Fax:662-377-7155
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR513849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112797Medicaid
MS500000208Medicare ID - Type Unspecified
MSS36429Medicare UPIN