Active NPI
Johnetta Ra'Shawn Carroll
- Gerontology Nurse Practitioner
- Headland, AL
National Provider Identifier
1407708100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 1-177842
- Practice address
- 208 Carr Cir
Headland, AL 36345-1906 - Phone
- (334) 718-2444
- NPI assigned
- Feb 13, 2026
- 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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 1-177842 | AL | Primary |
Addresses
Primary practice location
208 Carr Cir
Headland, AL 36345-1906
Mailing address
208 Carr Cir
Headland, AL 36345-1906
Phone (334) 718-2444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-177842 | AL | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1770940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1770940800000",
"number": "1407708100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 CARR CIR",
"city": "HEADLAND",
"state": "AL",
"postal_code": "363451906",
"telephone_number": "334-718-2444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 CARR CIR",
"city": "HEADLAND",
"state": "AL",
"postal_code": "363451906",
"telephone_number": "334-718-2444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "JOHNETTA",
"middle_name": "RA'SHAWN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-02-13",
"last_updated": "2026-02-13",
"certification_date": "2026-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "AL",
"license": "1-177842",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Headland, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.