Carrie McGrew Gholston

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

903621 Issued in MS

Practice address

141 Township Ave Ste 107
Ridgeland, MS 39157-8697

Phone

(601) 707-5676

NPI assigned

Oct 17, 2019

Last updated

Oct 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Carrie Elizabeth McGrew Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 13, 2025 through May 13, 2027

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lighthouse Healing Center, LLC

  • Adult Mental Health Clinic/Center
  • Ridgeland, MS
  • NPI 1871257824
  NPD Authorized official
• Lighthouse Healing Center, LLC

  • Mental Health Counselor
  • Ridgeland, MS
  • NPI 1316511066
  NPD
• Jackson Psychiatry Group

  • Psychiatric/Mental Health Nurse Practitioner
  • Ridgeland, MS
  • NPI 1790087393
  NPD (past)

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1902448301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 PALIN DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106962",
            "telephone_number": "601-720-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 TOWNSHIP AVE STE 107",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391578697",
            "telephone_number": "601-707-5676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHOLSTON",
        "first_name": "CARRIE",
        "middle_name": "MCGREW",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-17",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "903621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARRIE",
            "last_name": "MCGREW",
            "middle_name": "ELIZABETH",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gentex Pharma (Gentex Pharma LLC)
• Alma Marie German, PT
• Dana Milling Germany, NP-C
• Thomas Ferris Gerrets Jr., D.M.D.
• Lisa Michelle Gestes
• Madison Alexandria Gibbs
• Vonnetta Gidley, M.S. CCC-SLP
• Edward Lee Gieger Jr., M.D.
• Konstantina Matheos Gilbert, LPC, LPCC, LPAT
• Tony Gines

• Psychiatric/Mental Health Nurse Practitioner in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.