Kaylise Angelle Trahan, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

28095 Issued in MS

Practice address

2100 Highway 61 N
Vicksburg, MS 39183-8211

Phone

(601) 883-5000

NPI assigned

Apr 14, 2018

Last updated

Jun 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS, LA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• App of Mississippi Ed, LLC

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1730687740
  Medicare reassignment NPD
• Grenada Emergency Group, LLC

  • Emergency Medicine Physician
  • Grenada, MS
  • NPI 1194388082
  Medicare reassignment NPD
• Independent Healthcare Management, Inc.

  dba S E Lackey Memorial Hospital

  • Critical Access Hospital
  • Forest, MS
  • NPI 1306909734
  Medicare reassignment NPD
• Jackson HB Medical Services LLC

  dba Merit Health Central

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1184305856
  Medicare reassignment NPD
• Natchez HB Medical Services LLC

  dba Merit Health Natchez

  • Emergency Medicine Physician
  • Natchez, MS
  • NPI 1770264459
  Medicare reassignment NPD
• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Medicare reassignment NPD
• Professional Emergency Medicine Management -- Lake Charles LLC

  • Emergency Medicine Physician
  • Lake Charles, LA
  • NPI 1023430766
  Medicare reassignment NPD
• Independent Healthcare Management, Inc.

  dba 35 South Family Medical

  • Rural Health Clinic/Center
  • Raleigh, MS
  • NPI 1871272724
  NPD
• State of Mississippi - University of Mississippi Medical Center

  • Prosthetic/Orthotic Supplier
  • Jackson, MS
  • NPI 1235019530
  NPD
• St Tammany Emergency Physicians Group LLC

  • Emergency Medicine Physician
  • Covington, LA
  • NPI 1891187654
  NPD (past)

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

{
    "created_epoch": "1523664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1023505161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391838211",
            "telephone_number": "601-883-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1850 Chadwick Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392043404",
            "country_code": "US",
            "telephone_number": "601-376-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-984-4004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRAHAN",
        "first_name": "KAYLISE",
        "middle_name": "ANGELLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-14",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "28095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• TK Surgical Solutions
• Nina Tomlinson
• Regina Toney
• Alan J Torrey, M.D.
• Total Care Specialty Pharmacy, LLC (Total Care Pharmacy)
• Tammani Trevillion, LPC
• Anita L Tribble, MD
• Trinity Prosthetic & Orthotics LLC
• Triumph Ministries, Inc. (Kings Empowerment Center)
• Cherie Tucker

• Emergency Medicine Physician in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Emergency Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.