Courtney Lynn Cruthirds, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Hattiesburg, MS
NPI 1285263103 · NPPES record last updated Sep 7, 2021
Key facts
- NPI
- 1285263103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 904869 (MS)
- Practice address
- 6051 U S Highway 49
Hattiesburg, MS 39401-7201 - Phone
- (601) 288-7000
- NPI assigned
- Apr 2, 2020
- Reactivated
- May 25, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 26
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Forrest County General Hospital
Practice addresses (Care Compare)
2117 Broadway Dr
Hattiesburg, MS 39402-3210
Phone (601) 288-8050
2255 Broadway Dr
Hattiesburg, MS 39402-3254
Phone (601) 288-4800
Hospital & facility affiliations
- Forrest General Hospital
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 |
|---|---|---|---|---|
| I20220225000036 | MS | Practitioner - Nurse Practitioner | 8628462256 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 914070 | MS | MD | Registered Nurse |
| 904869 | MS | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forrest County General Hospital | Current |
Accepting new patients | |
| Forrest County General Hospital | Current |
Accepting new patients | |
| Forrest County General Hospital | Current | Accepting new patients |
Locations
1 Lincoln Pkwy
Ste 202
Hattiesburg, MS 39402
Phone (601) 288-8050
2117 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-8050
6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690
2255 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-2273
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 914070 | MS | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 904869 | MS | Yes |
Addresses
Primary practice location
6051 U S Highway 49
Hattiesburg, MS 39401-7201
Mailing address
2255 Broadway Dr
Hattiesburg, MS 39402-3254
Phone (601) 288-7000
Other providers in Hattiesburg, MS
- Samuel N Crosby
- Juanda Croson
- Ashleigh Crow
- Grover Scott Cruise
- William Jayson Allen Crum
- Cryo Solutions, Inc.
- Meghan Cule
- Jacklyn Cummins
- Lauryn Elizabeth Cunningham
- Steven G Cunningham
All providers in Hattiesburg, 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 Sep 7, 2021. 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.