Carla Diane Diffenderfer, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

901969 Issued in MS

Practice address

11516 Lamey Bridge Rd Ste I
Diberville, MS 39540

Phone

(228) 207-4190

Fax

(228) 207-4156

NPI assigned

Oct 21, 2013

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

Other identifiers 1

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.

• D'Iberville Medical Clinic LLC

  • Family Medicine Physician
  • Diberville, MS
  • NPI 1629536925
  NPD (past)
• The Surgical Clinic

  • Family Medicine Physician
  • Diberville, MS
  • NPI 1689851479
  NPD (past)

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

{
    "created_epoch": "1382313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1467880922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1277",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395331277",
            "telephone_number": "228-207-4190",
            "fax_number": "228-207-4156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11516 LAMEY BRIDGE RD STE I",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "39540",
            "telephone_number": "228-207-4190",
            "fax_number": "228-207-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIFFENDERFER",
        "first_name": "CARLA",
        "middle_name": "DIANE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-21",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "18523",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "901969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP2607",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Rachelle Cuevas, PHARMD
• D'Iberville Chiropractic Clinic, Inc.
• D'Iberville Medical Clinic LLC
• Andrea L Davis, D.D.S.
• Diberville Medical Spa
• Shekina T Dillon, NURSE PRACTITIONER
• Sarah Sage Dolbear, M.D
• Maria Morrison Dominick, PMHNP
• Ellen Donaldson
• Rhonda Dunaway, RPH

• All providers in Diberville, MS
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; 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.