Collietta C Bassett

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

903239 Issued in MS

Practice address

2555 Caffey St
Hernando, MS 38632-2116

Phone

(901) 351-0962

NPI assigned

Jan 24, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MS, TN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ultra Health LLC 151 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Ultra Health LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Nashville, TN
  • NPI 1922469543

  TN

  Medicare reassignment Care Compare group
• First Counseling Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Olive Branch, MS
  • NPI 1255631610

  MS

  Medicare reassignment NPD
• Ultra Health Providers II LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Nashville, TN
  • NPI 1033956057

  TN

  Medicare reassignment

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

{
    "created_epoch": "1548288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789084800000",
    "number": "1063976983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3730 SAINT PHILIP DR",
            "city": "BARTLETT",
            "state": "TN",
            "postal_code": "381334216",
            "telephone_number": "901-240-4859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 CAFFEY ST",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386322116",
            "telephone_number": "901-351-0962"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3909 Covington Pike",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381352281",
            "country_code": "US",
            "telephone_number": "731-394-1145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BASSETT",
        "first_name": "COLLIETTA",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-24",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WV",
            "license": "110891",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "903239",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "25447",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Renee Aycock
• Amanda Bagwell
• Kristi Baker
• Taylor Barker, MA, SLP-CF
• Megan Barton, COTA
• Sharon Denise Battle, LMSW-TN
• John Aristide Bienvenu, PHARMD
• Latonya Shontae Binion
• Robin Vanessa Blaisdell
• Bledsoe Premier Home Health Care LLC

• All providers in Hernando, MS
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.