Provider Demographics
NPI:1316488729
Name:MCCRIMMON, CAROL SUZANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:SUZANNE
Last Name:MCCRIMMON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19441 HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MS
Mailing Address - Zip Code:38917
Mailing Address - Country:US
Mailing Address - Phone:662-595-4114
Mailing Address - Fax:662-595-4117
Practice Address - Street 1:19441 HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MS
Practice Address - Zip Code:38917
Practice Address - Country:US
Practice Address - Phone:662-595-4114
Practice Address - Fax:662-595-4117
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901880363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner