NPIMap

Organization Active NPI

Mysti Blu Management Group, LLC

  • Home Infusion Agency
  • Carrollton, TX
National Provider Identifier
1003632522
Registry record updated Nov 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion AgencyTaxonomy code 251F00000X
Legal business name
MYSTI BLU MANAGEMENT GROUP, LLC
Practice address
2459 E Hebron Pkwy Ste 130
Carrollton, TX 75010-4477
Phone
(972) 522-9799
Fax
(469) 546-9723
NPI assigned
Nov 30, 2024
Last updated
Nov 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jerria Bernestine, FNP-CNPI 1578024931
Title
Owner
Phone
(310) 756-4829

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Home Infusion Agency 251F00000X Primary
Infusion Therapy Clinic/Center 261QI0500X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

2459 E Hebron Pkwy Ste 130
Carrollton, TX 75010-4477

Mailing address

2459 E Hebron Pkwy Ste 130
Carrollton, TX 75010-4477
Phone (972) 522-9799

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732924800000",
    "number": "1003632522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2459 E HEBRON PKWY STE 130",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104477",
            "telephone_number": "972-522-9799",
            "fax_number": "469-546-9723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2459 E HEBRON PKWY STE 130",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104477",
            "telephone_number": "972-522-9799",
            "fax_number": "469-546-9723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTI BLU MANAGEMENT GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-30",
        "last_updated": "2024-11-30",
        "certification_date": "2024-11-30",
        "status": "A",
        "authorized_official_last_name": "BERNESTINE",
        "authorized_official_first_name": "JERRIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-756-4829",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.