Stacey A. Carter, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R881362 Issued in MS

Practice address

2500 N State St
Jackson, MS 39216-4500

Phone

(601) 815-0115

Fax

(601) 984-5257

NPI assigned

Feb 1, 2008

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

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revitalize Hydration Therapy LLCGroup PAC ID 5193154128, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: scarter5998@ummc.direct-ci.com

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

• Revitalize Hydration Therapy, LLC

  • Gerontology Nurse Practitioner
  • Flowood, MS
  • NPI 1285261123
  Medicare reassignment Care Compare group
• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Medicare reassignment
• Moore Family Medical PLC

  • Family Nurse Practitioner
  • Murfreesboro, TN
  • NPI 1174720981
  NPD (past)

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

{
    "created_epoch": "1201824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339632000000",
    "number": "1528246576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-0115",
            "fax_number": "601-984-5257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-0115",
            "fax_number": "601-984-5257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTER",
        "first_name": "STACEY",
        "middle_name": "A.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-01",
        "last_updated": "2012-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "13075",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R881362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06826705",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Link Carter, CRNA
• Keith Landon Carter, MD
• Kenneth Carter, M.D.
• Lillian Rose Carter
• Macy Moore Carter
• Tara P. Carter, AGACNP
• William Carter, M.D.
• Wanda Carthledge
• Veronica P Carullo, M.D.
• Donald R Carver Jr., CRNA

• Family Nurse Practitioner in Jackson, MS
• Providers in Jackson, 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 14, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.