Teresa Conerly, NPC
Individual provider Active NPI Family Nurse Practitioner · Monticello, MS
NPI 1285065292 · NPPES record last updated Oct 14, 2016
Key facts
- NPI
- 1285065292
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R855066 (MS)
- Practice address
- 430 W Broad St
Monticello, MS 39654-7723 - Phone
- (601) 825-7280
- Fax
- (601) 825-8130
- NPI assigned
- Dec 2, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ms State Department of Health
Practice addresses (Care Compare)
1850 Cheryl St
Clarksdale, MS 38614-7219
Phone (662) 624-8316
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 |
|---|---|---|---|---|
| I20140318000261 | MS | Practitioner - Nurse Practitioner | 5092946996 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R855066 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Care Clinic, Inc. | Current | Accepting new patients | |
| Family Health Care Clinic, Inc. | Current |
Accepting new patients | |
| Family Health Care Clinic, Inc. | Current |
Accepting new patients | |
| Mississippi State Department of Health | Current | Accepting new patients |
Locations
290 Highway 51 N
Brookhaven, MS 39601
Phone (601) 823-1710
570 E Woodrow Wilson Ave
Jackson, MS 39216
Phone (601) 576-7345
430 W Broad St
Monticello, MS 39654
Phone (601) 587-4492
4635 Highway 80 E
Pearl, MS 39208
Phone (601) 933-2500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R855066 | MS | Yes |
Addresses
Primary practice location
430 W Broad St
Monticello, MS 39654-7723
Mailing address
12 McCray Rd
Jayess, MS 39641-8053
Other providers in Monticello, MS
- Caring Hands Children'S Clinic, LLC
- Caring Hands Family Practice, LLC
- Robin Catchings
- Nicollette Shautria Clark
- Dwan C Cole-Bridges
- Jack Douglas
- Downhome Pharmacy, Inc.
- Durable Medical Equipment South, LLC
- Durable Medical Equipment South, LLC
- Daniel Esta
All providers in Monticello, 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 Oct 14, 2016. 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.