Mary Manning Booker, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Southaven, MS
NPI 1295596575 · NPPES record last updated Jan 23, 2024
Key facts
- NPI
- 1295596575
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 906387 (MS)
- Practice address
- 2686 Pinnacle Dr
Southaven, MS 38672-6595 - Phone
- (662) 306-3081
- NPI assigned
- Jan 23, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R887767 | MS | MD | Psychiatric/Mental Health Registered Nurse |
| 906387 | MS | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nurseplugconnect PLLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | R887767 | MS | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 906387 | MS | Yes |
Addresses
Primary practice location
2686 Pinnacle Dr
Southaven, MS 38672-6595
Mailing address
2686 Pinnacle Dr
Southaven, MS 38672-6595
Phone (662) 306-3081
Other providers in Southaven, MS
- Blush Medical Aesthetics & Wellness
- Stephen Bolivar
- Bailey Miller Bonds
- Steven Bonham
- Felicia Booker
- Shannon Gale Bouchillon
- Aaron Tate Boyd
- Justin Boyd
- Kelsey Boyd
- Tiffany Boyd
All providers in Southaven, 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 Jan 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.