Carla Brown, FNP-BC
Individual provider Active NPI Nurse Practitioner · Liberty, MS
NPI 1013227743 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1013227743
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- R886751 (MS)
- Practice address
- 102 West Freedom Drive
Liberty, MS 39645-0511 - Phone
- (601) 657-8091
- Fax
- (225) 657-1085
- NPI assigned
- Oct 15, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP08105 | LA | MD | Family Nurse Practitioner |
Interoperability endpoints
- https://api.platform.athenahealth.com/22116/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP08105 | LA | |
| Nurse Practitioner | 363L00000X | R886751 | MS | Yes |
Addresses
Primary practice location
102 West Freedom Drive
Liberty, MS 39645-0511
Mailing address
PO Box 511
Liberty, MS 39645-0511
Phone (601) 657-8091
Other practice location 1
300 Rawls Dr Ste 1300
McComb, MS 39648-2866
Phone (601) 249-3541 ext. 712
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08587279 | Medicaid | MS |
Other providers in Liberty, MS
- Amite County School District
- Amite County School District
- Micaela Temple Andrus
- Matthew Blalock
- Shelby Belle Blalock
- Rebecca Claire Campbell
- Care One Health
- Care One Health LLC
- Lee Daniel Casey
- CLC of Liberty, LLC
All providers in Liberty, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.