Active NPI
Carley Marie Mayberry, RN
- Registered Nurse
- Gulfport, MS
National Provider Identifier
1215705173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 153254
- Practice address
- 5502 Marvin Shields Blvd
Gulfport, MS 39501 - Phone
- (913) 837-0691
- NPI assigned
- Dec 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 153254 | KS | Primary |
Addresses
Primary practice location
5502 Marvin Shields Blvd
Gulfport, MS 39501
Mailing address
2065B Appleway CT
Gulfport, MS 39501-5052
Phone (913) 837-0691
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 153254 | KS | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702944000000",
"number": "1215705173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2065B APPLEWAY CT",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395015052",
"telephone_number": "913-837-0691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5502 MARVIN SHIELDS BLVD",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39501",
"telephone_number": "913-837-0691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYBERRY",
"first_name": "CARLEY",
"middle_name": "MARIE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-19",
"last_updated": "2023-12-19",
"certification_date": "2023-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "KS",
"license": "153254",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.