Chandra Anita Boston, C.F.P.M.H.N.P.
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Jackson, MS
NPI 1043249295 · NPPES record last updated Feb 5, 2016
Key facts
- NPI
- 1043249295
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- R772275 (MS)
- Practice address
- 2500 North State Street
Jackson, MS 39216-4500 - Phone
- (601) 815-4128
- Fax
- (601) 815-1828
- NPI assigned
- Jul 1, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Region VI Community Mental Health Commission
Practice addresses (Care Compare)
PO Box
Greenwood, MS 38935-1505
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080612000885 | MS | Practitioner - Nurse Practitioner | 3779654041 |
Reassigns benefits to 3 organizations Practice locations: Pearl, MS |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R772275 | MS | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brentwood Acquisition Inc | Current |
Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients | |
| Region VI Community Mental Health Commission | Current |
Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients | |
| Garden Park | Past | Accepting new patients | |
| American Psych Associates, Inc. | Past | Accepting new patients |
Locations
2500 N State St
Jackson, MS 39216
Phone (601) 815-4775
3531 Lakeland Dr
Jackson, MS 39232
Phone (601) 936-2024
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R772275 | MS | Yes |
Addresses
Primary practice location
2500 North State Street
Jackson, MS 39216-4500
Mailing address
PO Box 157a
Whitfield, MS 39193-0157
Phone (601) 351-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09528347 | Medicaid | MS |
Other providers in Jackson, MS
- Brian Bahman Borg
- Irina V Borissova
- Paulo Antonio Borjas Mendoza
- Michael Jude Borne
- Barbara Janet Boss
- Meredith Celeste Boston
- Belmont Boswell
- Bryant Ridgway Boswell
- Peter John Boswell
- Zachary Gage Boswell
All providers in Jackson, 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 Feb 5, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.