Active NPI
Stacey Neubauer Kitchens, PMHNP
- Nurse Practitioner
- Jackson, MS
National Provider Identifier
1114443678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 902210
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-4700
- NPI assigned
- Aug 16, 2017
- Last updated
- Aug 16, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 902210 | MS | Primary |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
2411 Culleywood Rd
Jackson, MS 39211-4917
Phone (601) 668-6025
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 902210 | MS | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Precise Psychopharmacology LLC | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502841600000",
"number": "1114443678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2411 CULLEYWOOD RD",
"city": "JACKSON",
"state": "MS",
"postal_code": "392114917",
"telephone_number": "601-668-6025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 N STATE ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164500",
"telephone_number": "601-984-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KITCHENS",
"first_name": "STACEY",
"middle_name": "NEUBAUER",
"name_prefix": "Mrs.",
"credential": "PMHNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-16",
"last_updated": "2017-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MS",
"license": "902210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2017; 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.