Provider Demographics
NPI:1487247235
Name:CARD, CHARLOTTE MACI (NP)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MACI
Last Name:CARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 PRESCOTT CARD RD
Mailing Address - Street 2:
Mailing Address - City:EUPORA
Mailing Address - State:MS
Mailing Address - Zip Code:39744-3609
Mailing Address - Country:US
Mailing Address - Phone:662-295-6234
Mailing Address - Fax:
Practice Address - Street 1:150 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-0428
Practice Address - Country:US
Practice Address - Phone:662-495-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS900829163W00000X
MS905866363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS905866OtherNURSE PRACTITIONER
MS104599566OtherWOMEN'S HEALTH NURSE PRACTITIONER