Carrie Lee Fernald, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

904256 Issued in MS

Practice address

215 Marion Ave
McComb, MS 39648-2705

Phone

(601) 249-5500

NPI assigned

Oct 28, 2020

Last updated

May 5, 2021By the provider in NPPES

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

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brookhaven Ear, Nose and Throat PAGroup PAC ID 5092809764, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• King's Daughters Medical Center-Brookhaven Hospital, Brookhaven, MS, CCN 250057

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Brookhaven Ear, Nose & Throat PA

  • Otolaryngology Physician
  • Brookhaven, MS
  • NPI 1225152580
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• King's Daughters Medical Center

  • General Acute Care Hospital
  • Brookhaven, MS
  • NPI 1972503464
  Care Compare affiliation

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

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1831799022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1537 MONTICELLO ST NE",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396018802",
            "telephone_number": "601-754-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 MARION AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482705",
            "telephone_number": "601-249-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNALD",
        "first_name": "CARRIE",
        "middle_name": "LEE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-28",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02304077",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Thomas Felder, DMD
• Renada T Felder
• Jodelle Kristine Dino Felipe, MD
• Jennifer Ferguson
• Brett Ferman, MD
• Jordan Felder Field, D.M.D.
• Mary Jill Fisher, LPC
• Alice Fletcher
• Christina Jolene Floyd, COTA/L
• Cindy Foley

• Family Nurse Practitioner in McComb, MS
• Providers in McComb, 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 May 5, 2021; 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.