NPIMap

Individual provider Active NPI

Erin Broome Riley, MSN, APRN FNP-C

  • Family Nurse Practitioner
  • Tylertown, MS
National Provider Identifier
1255063996
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
905309 Issued in MS
Practice address
200 Hospital Dr
Tylertown, MS 39667-2020
Phone
(601) 876-5835
Fax
(601) 876-5295
NPI assigned
Jun 30, 2022
Last updated
Feb 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 905309 MS Primary

Addresses

Primary practice location

200 Hospital Dr
Tylertown, MS 39667-2020

Mailing address

200 Hospital Dr
Tylertown, MS 39667-2020
Phone (601) 876-5835

Other practice location 1

1014 Rose St.
Prentiss, MS 39474-5271
Phone (601) 792-2200

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
I20220823000845 MS Practitioner - Nurse Practitioner 7416330717 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Walthall General HospitalGroup PAC ID 3678766094, 7 clinicians
Forrest County General HospitalGroup PAC ID 1052397767, 107 clinicians

Practice addresses (Care Compare)

100 Hospital Dr
Tylertown, MS 39667-2022
Phone (601) 876-2122

1014 Rose St
Prentiss, MS 39474-5271
Phone (601) 792-2200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
905309MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince Jul 18, 2022 Accepting new patients
Forrest County General Hospital CurrentSince Jul 18, 2022 Accepting new patients
Walthall General Hospital CurrentSince Sep 28, 2023 Accepting new patients
Walthall General Hospital CurrentSince Sep 28, 2023 Accepting new patients
Forrest County General Hospital Current Accepting new patients
Walthall General Hospital Past Accepting new patients
Walthall County General Hospital Past Accepting new patients

Locations

1560 Sumrall Rd
Columbia, MS 39429
Phone (601) 736-6303

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

100 Hospital Dr
Tylertown, MS 39667
Phone (601) 876-0455

200 Hospital Dr
Tylertown, MS 39667
Phone (601) 876-5303

Organizations & group practices 7

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1656547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1255063996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "396672020",
            "telephone_number": "601-876-5835",
            "fax_number": "601-876-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "396672020",
            "telephone_number": "601-876-5835",
            "fax_number": "601-876-5295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1014 Rose St.",
            "address_purpose": "LOCATION",
            "city": "Prentiss",
            "state": "MS",
            "postal_code": "394745271",
            "country_code": "US",
            "telephone_number": "601-792-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RILEY",
        "first_name": "ERIN",
        "middle_name": "BROOME",
        "name_prefix": "Mrs.",
        "credential": "MSN, APRN FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-30",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "905309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tylertown, MS

Sources for this page

Verify at the official NPI Registry.