Provider Demographics
NPI:1427501857
Name:CARROLL, VICTORIA L (MSN, PMHNP-BC, RN)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:L
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC, RN
Other - Prefix:MRS
Other - First Name:TORI
Other - Middle Name:L
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, PMHNP-BC, RN
Mailing Address - Street 1:364 S FRONT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4161
Mailing Address - Country:US
Mailing Address - Phone:901-296-3000
Mailing Address - Fax:949-543-2924
Practice Address - Street 1:364 S FRONT ST STE 201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4161
Practice Address - Country:US
Practice Address - Phone:901-296-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901673363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1035I00515OtherMEDICARE TN
MS541991YSWNOtherMEDICARE MS
TNQ025591Medicaid
MS08934772Medicaid