Provider Demographics
NPI:1003840646
Name:SUMRALL, CARYL P (FNP)
Entity type:Individual
Prefix:
First Name:CARYL
Middle Name:P
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2035
Mailing Address - Country:US
Mailing Address - Phone:601-952-8398
Mailing Address - Fax:833-972-5586
Practice Address - Street 1:6311 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2035
Practice Address - Country:US
Practice Address - Phone:601-952-8398
Practice Address - Fax:833-972-5586
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119136Medicaid
MSRR 500010219OtherRAILROAD
LA1114405Medicaid
MS00119136Medicaid
LA1114405Medicaid
MS512I500054Medicare PIN