Jackie C Dyess, C. A. P. M. H. N. P.
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Whitfield, MS
NPI 1003972928 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003972928
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- R853574 (MS)
- Practice address
- 3550 Highway 468 West
Whitfield, MS 39193-0157 - Phone
- (601) 351-8000
- Fax
- (601) 351-8301
- NPI assigned
- Dec 28, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R853574 | MS | Yes |
Addresses
Primary practice location
3550 Highway 468 West
Whitfield, MS 39193-0157
Mailing address
PO Box 157a
Whitfield, MS 39193-0157
Phone (601) 351-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05859567 | Medicaid | MS |
Other providers in Whitfield, MS
- Charlisa Crawford
- Wendell J Crawford
- Salaahuddin Dakhlalla
- Shonna Pruitt Davis
- Kirtida Dipakkumar Desai
- Waleed El Harith
- Craig Leopold Escude
- Patrick Michael Fitz-Gerald
- Andrew William Foret
- Shazia Mulkana Frothingham
All providers in Whitfield, MS · Psychiatric/Mental Health Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.