Sondra Michelle Bennett, PMHNP-BC

Key facts

NPI: 1275970725
Entity type: Individual (NPI type 1)
Primary specialty: Psychiatric/Mental Health Nurse Practitioner 363LP0808X
License: 859958 (MS)
Practice address: 2434 S Eason Blvd
Tupelo, MS 38804-6942
Phone: (662) 844-1717
Fax: (662) 680-6416
NPI assigned: May 23, 2013
Sex: Female
Sole proprietor: Yes

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 and National Provider Directory roles.

Northeast Mental Health-Mental Retardation Commission Rural Health Clinic/Center · Tupelo, MS · NPI 1548413628

Medicare reassignment Care Compare group NPD MS

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2012
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Northeast Mental Health-Mental Retardation Commission (10 clinicians)

Practice addresses (Care Compare)

499 Gloster Creek VLG
Tupelo, MS 38801-4600
Phone (662) 844-1717

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
I20141201000038	MS	Practitioner - Nurse Practitioner	6103054796	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

State licenses

License	State	Type	Specialty
859958	MS	MD	Psychiatric/Mental Health Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Northeast Mental Health-Mental Retardation Commission		Current	Accepting new patients

Locations

2434 S Eason Blvd
Tupelo, MS 38804
Phone (662) 640-4595

499 Gloster Creek Vlg
Ste A3
Tupelo, MS 38801
Phone (662) 640-4595

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychiatric/Mental Health Nurse Practitioner	363LP0808X	859958	MS	Yes

Addresses

Primary practice location

2434 S Eason Blvd
Tupelo, MS 38804-6942

Mailing address

144 S Thomas St Ste 207
Tupelo, MS 38801-5337
Phone (662) 205-6905

Other providers in Tupelo, MS

All providers in Tupelo, MS · Psychiatric/Mental Health 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 Aug 7, 2019. 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.

Verify at the official NPI Registry.