Provider Demographics
NPI:1982115945
Name:NURSE PRACTITIONER HOUSE CALLS
Entity type:Organization
Organization Name:NURSE PRACTITIONER HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-513-8508
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39355-0838
Mailing Address - Country:US
Mailing Address - Phone:601-513-8508
Mailing Address - Fax:601-557-4181
Practice Address - Street 1:109 E DONALD ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:MS
Practice Address - Zip Code:39355-2310
Practice Address - Country:US
Practice Address - Phone:601-513-8508
Practice Address - Fax:601-557-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS862287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS862287OtherMS FNP LICENSE