Ethan Tyler Smitherman, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

905753 Issued in MS

Practice address

324 W Valley St Ste 108
Hernando, MS 38632-1749

Phone

(901) 491-0130

NPI assigned

Feb 1, 2023

Last updated

Feb 1, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Hernando Psychiatry LLC

  dba Hernando Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Hernando, MS
  • NPI 1912600750
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1675209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1316643398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 W VALLEY ST STE 108",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386321749",
            "telephone_number": "901-491-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 W VALLEY ST STE 108",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386321749",
            "telephone_number": "901-491-0130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITHERMAN",
        "first_name": "ETHAN",
        "middle_name": "TYLER",
        "name_prefix": "Mr.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-01",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "905753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa A Smith, RN
• Lora Michelle Smith, FNP
• Melissa Renee Smith, APRN
• Miranda Smith
• Robert Lewis Smith Jr., DDS
• Soul ABA LLC
• Southern Health Clinic, LLC
• Southern Pediatric Therapy
• Southern Serenity Counseling, LLC
• Spectrum Counseling & Wellness

• Psychiatric/Mental Health Nurse Practitioner in Hernando, MS
• Providers in Hernando, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (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.