NPIMap

Individual provider Active NPI

Krystal Lynn Sitthivong, CNP

  • Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1205440898
Registry record updated Dec 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
904763 Issued in MS
Practice address
4500 13TH St
Gulfport, MS 39501-2569
Phone
(228) 867-4499
Fax
(228) 867-5027
NPI assigned
Sep 1, 2020
Last updated
Dec 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 904763 MS Primary

Addresses

Primary practice location

4500 13TH St
Gulfport, MS 39501-2569

Mailing address

PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 575-1194

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211213000961 MS Practitioner - Nurse Practitioner 9234529918 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2465

1440 Central Ave E
Wiggins, MS 39577-9602
Phone (601) 928-6700

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-3152

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince Nov 15, 2021 Accepting new patients

Locations

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

Interoperability endpoints

  • Direct secure messaging: ksitthivong@direct.mhg.com

Organizations & group practices 3

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.

Hospital & facility affiliations 60

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1205440898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395021810",
            "telephone_number": "228-575-1194",
            "fax_number": "228-575-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 13TH ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012569",
            "telephone_number": "228-867-4499",
            "fax_number": "228-867-5027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SITTHIVONG",
        "first_name": "KRYSTAL",
        "middle_name": "LYNN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-01",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "904763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.