Carly Jo Meredith, CFNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R885265 Issued in MS

Practice address

1601 Strong Ave
Greenwood, MS 38930-4037

Phone

(662) 451-7565

NPI assigned

Oct 5, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308528000000",
    "number": "1487963724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E JEFF DAVIS AVE",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389302318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 STRONG AVE",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389304037",
            "telephone_number": "662-451-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEREDITH",
        "first_name": "CARLY",
        "middle_name": "JO",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-05",
        "last_updated": "2011-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R885265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04734769",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea McMath
• Terry Y McMillin, MD
• Med-Trans Corporation
• Selina Renee Medders, M. ED., CMHT
• Memorial Hospice, Inc.
• Michael T. Boler, M.D.
• Ashton Chandrae Miller, PCMHT, M.ED.
• Jimmy Miller, MD
• Kela Miller
• Lashundra Miller

• Family Nurse Practitioner in Greenwood, MS
• Providers in Greenwood, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; 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.