Devetta Harris
Individual provider Active NPI Family Nurse Practitioner · Canton, MS
NPI 1235975152 · NPPES record last updated Jul 2, 2024
Key facts
- NPI
- 1235975152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 906772 (MS)
- Practice address
- 122 E Academy St
Canton, MS 39046-4502 - Phone
- (601) 859-8998
- NPI assigned
- Jul 2, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Minor Med Care, LLC
Uppal Medical Center LLC
MDB Behavioral Health Services LLC
Practice addresses (Care Compare)
120 W Main St
Raymond, MS 39154-1223
Phone (601) 857-2341
1727 E Union St
Greenville, MS 38703-3253
Phone (662) 537-4830
1911 Mission
66 Suite B
Vicksburg, MS 39180-3762
Phone (601) 456-2598
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 |
|---|---|---|---|---|
| I20251210003427 | MS | Practitioner - Nurse Practitioner | 2163916818 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 906772 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minor Med Care, LLC | Current |
Accepting new patients | |
| MDB Care Management LLC | Current |
Accepting new patients | |
| Heal All Wound Care LLC | Current |
Accepting new patients | |
| MDB Behavioral Health Services LLC | Current |
Accepting new patients | |
| Uppal Medical Center LLC | Current |
Accepting new patients | |
| Minor Med Care, LLC | Current |
Accepting new patients | |
| Devoted Nursing Care | Current | Accepting new patients | |
| Heal All Wound Care LLC | Past |
Accepting new patients |
Locations
122 E Academy St
Canton, MS 39046
Phone (601) 859-1308
660 Lakeland East Dr
Ste 210
Flowood, MS 39232
Phone (601) 664-4162
1727 E Union St
Greenville, MS 38703
Phone (662) 332-0373
2860 McDowell Road Ext
Jackson, MS 39204
Phone (601) 372-1117
215 Katherine Dr
#A
Jackson, MS 39232
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 906772 | MS | Yes |
Addresses
Primary practice location
122 E Academy St
Canton, MS 39046-4502
Mailing address
122 E Academy St
Canton, MS 39046-4502
Phone (601) 859-8998
Other providers in Canton, MS
- H.F.Young Transportation, Inc.
- Julie Hamilton
- Phyllis T Hammond
- Janay Latashia Harper
- Kelly Harrington
- Healthy You Medical Clinic LLC
- Hess Hembree IV
- Addie Parks Herrod
- Hicks Gynecology PC
- Hicks Healthcare Center for Women
All providers in Canton, MS · Family 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 Jul 2, 2024. 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.