Carroll Logan Vincent, APN ,PMHNP- BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APN0000007369 Issued in TN

Practice address

1997 Highway 51 S
Professional Care Services of West TN, Inc.
Covington, TN 38019-3630

Phone

(901) 476-8967

Fax

(901) 313-1125

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Platte Nebraska Physician Group LLC

  • Emergency Medicine Physician
  • North Platte, NE
  • NPI 1740465715
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1255359717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1997 HIGHWAY 51 S",
            "address_2": "PROFESSIONAL CARE SERVICES OF WEST TN, INC.",
            "city": "COVINGTON",
            "state": "TN",
            "postal_code": "380193630",
            "telephone_number": "901-476-8967",
            "fax_number": "901-313-1125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1997 HIGHWAY 51 S",
            "address_2": "PROFESSIONAL CARE SERVICES OF WEST TN, INC.",
            "city": "COVINGTON",
            "state": "TN",
            "postal_code": "380193630",
            "telephone_number": "901-476-8967",
            "fax_number": "901-313-1125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCENT",
        "first_name": "CARROLL",
        "middle_name": "LOGAN",
        "name_prefix": "Ms.",
        "credential": "APN ,PMHNP- BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "APN0000007369",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NE",
            "license": "111003",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• University of Tennessee
• Deborah L Vanbeukering, D.O.
• Andrew Richard Vancleve, DPH
• Robyn Y. Vanderford, FNP
• Huy VI
• Dejo Viprakasit, MD
• Suttiwara Viprakasit, MD
• Wade Family Medicine, LLC.
• Modeanna Leigh Wade, APRN
• Wal-Mart Stores East LP

• Psychiatric/Mental Health Nurse Practitioner in Covington, TN
• Providers in Covington, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.

Verify at the official NPI Registry.