Latasha Jackson Claiborne, PMHNP

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

163W00000X Issued in MS

Practice address

3444 Wisconsin Ave
Vicksburg, MS 39180-5331

Phone

(601) 638-0031

NPI assigned

Aug 3, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Latasha Jackson Claiborrne Professional name

Medicare fee-for-service enrollment

Enrolled in MS

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 1

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Warren Yazoo Mental Health ServiceGroup PAC ID 2365418167, 10 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.

• Warren Yazoo Mental Health Service

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vicksburg, MS
  • NPI 1023002920

  MS

  Medicare reassignment Care Compare group NPD
• Positive Pathways, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vicksburg, MS
  • NPI 1801335492
  NPD
• Southwest Mississippi Mental Health Mental Retardation Commission

  • Social Worker
  • McComb, MS
  • NPI 1366694820
  NPD (past)

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

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679011200000",
    "number": "1104104413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 WHITE ST",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "39648",
            "telephone_number": "601-249-4214",
            "fax_number": "601-249-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3444 WISCONSIN AVE",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805331",
            "telephone_number": "601-638-0031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1905 Mission 66",
            "address_purpose": "LOCATION",
            "city": "Vicksburg",
            "state": "MS",
            "postal_code": "391803711",
            "country_code": "US",
            "telephone_number": "601-738-5820",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 White St",
            "address_purpose": "LOCATION",
            "city": "McComb",
            "state": "MS",
            "postal_code": "39648",
            "country_code": "US",
            "telephone_number": "601-249-4214",
            "fax_number": "601-249-1062",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLAIBORNE",
        "first_name": "LATASHA",
        "middle_name": "JACKSON",
        "name_prefix": "Mrs.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-03",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "904842",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "163W00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LATASHA",
            "last_name": "CLAIBORRNE",
            "middle_name": "JACKSON",
            "prefix": "MRS.",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Susan A Chiarito, MD
• Albert F Chiemprabha, MD
• Tamberline Chiplin II
• Christina Hossley Inc
• Jasmine Claiborne
• Antionette K Clark
• Robin Clark, PCMHT
• Lindy Clifton
• Linda Coats
• Brooke F. Coffelt, PHARMD

• All providers in Vicksburg, MS
• Registered Nurse in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; 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.