| Doctor Name: | MRS. CAROLYN VETTA RUSSELL |
| NPI Number: | 1811082191 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, RN, CFNP |
| License Number: | 143980 |
| Business Practice Address: | 840 N Oak Ave Ruleville, MS - 387713227 |
| Business Phone Number: | 6627562711 |
| Business Fax Number: | 6627564114 |
| Mailing Address: | 121 Girl Scout Rd, GRENADA |
| State: | MS |
| Postal Code: | 389019283 |
| Phone Number: | 6622267311 |
| Fax Number: | |
| NPI Enumeration Date: | 10/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 143980 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |