Dortha Leona Carnathan, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R582581 Issued in MS

Practice address

910 Mary Vance Dr
Tupelo, MS 38801

Phone

(662) 377-6275

Fax

(662) 377-6299

NPI assigned

Apr 2, 2008

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 identifiers 1

Other names 1

• Mrs. Dortha Leona Wilson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• North Mississippi Medcial Center, Inc.

  dba Radiology Consultants

  • Diagnostic Radiology Physician
  • Tupelo, MS
  • NPI 1902762487
  NPD (past)

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463356800000",
    "number": "1922271600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 MARY VANCE DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38801",
            "telephone_number": "662-377-6275",
            "fax_number": "662-377-6299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 MARY VANCE DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38801",
            "telephone_number": "662-377-6275",
            "fax_number": "662-377-6299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARNATHAN",
        "first_name": "DORTHA",
        "middle_name": "LEONA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-02",
        "last_updated": "2016-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R582581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500263208",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DORTHA",
            "last_name": "WILSON",
            "middle_name": "LEONA",
            "prefix": "MRS.",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cardiothoracic Surgery Clinic of North Ms
• Caring Hands Health Care Services
• Caring Hands Healthcare
• Caring Heart Personal Care Services, LLC
• Desiree Wasinger Carnathan, M.ED.
• Nikolas Doyle Carnathan, OTR/L
• Tareka Latricia Carney
• Richard A Caron, D.M.D., P.A
• David Alfred Carpenter, NCC, LPC
• Paula Anglin Carpenter, LMSW

• Family Nurse Practitioner in Tupelo, MS
• Providers in Tupelo, 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 16, 2016; 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.