Nicole Elise Carden, M.D.
Individual provider Active NPI Pediatrics Physician · Petal, MS
NPI 1609288141 · NPPES record last updated May 31, 2024
Key facts
- NPI
- 1609288141
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 25302 (MS)
- Practice address
- 50 Parkway LN Ste C
Petal, MS 39465-3035 - Phone
- (601) 705-0260
- Fax
- (601) 261-3583
- NPI assigned
- Jun 2, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180905002484 | MS | Practitioner - Pediatric Medicine | 6507180353 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25302 | MS | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hattiesburg Clinic PA | Single Specialty | Current |
Accepting new patients |
| Hattiesburg Clinic, PA | Current |
Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Past |
Accepting new patients | |
| Hattiesburg Clinic, PA | Past | Accepting new patients | |
| Forrest County General Hospital | Past | Accepting new patients |
Locations
415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606
50 Parkway Ln
Ste C
Petal, MS 39465
Phone (601) 705-0260
206 Old Corinth Rd
Petal, MS 39465
Phone (601) 544-7404
Interoperability endpoints
- ncarden75125@directpatientrecord.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | 25302 | MS | Yes |
Addresses
Primary practice location
50 Parkway LN Ste C
Petal, MS 39465-3035
Mailing address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 705-0260
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04575251 | Medicaid | MS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ncarden75125@directpatientrecord.com | Health Information Exchange (HIE) |
Other providers in Petal, MS
- Ronald A Bullock
- Tammy Bullock
- John Paul Bumgardner
- Emily Cade
- Patricia Lurline Campbell
- Caring Starts Here
- Sheila S Carney
- Kimberly Marie Chapman
- Cline Consulting Services LLC
- Brian Michael Cline
All providers in Petal, MS · Pediatrics Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.