Provider Demographics
NPI:1982326120
Name:CARPENTER, ERIN RAE (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:RAE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6300 E LAKE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-6771
Mailing Address - Country:US
Mailing Address - Phone:228-230-2663
Mailing Address - Fax:228-546-3257
Practice Address - Street 1:1720A MEDICAL PARK DR STE 220
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2127
Practice Address - Country:US
Practice Address - Phone:228-230-2663
Practice Address - Fax:228-546-3257
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS905424363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner