Active NPI
Collaborativenp Health Center LLC
- Family Nurse Practitioner
- Osyka, MS
National Provider Identifier
1316728512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- COLLABORATIVENP HEALTH CENTER LLC
- Practice address
- 1081 Second St
Osyka, MS 39657-8076 - Phone
- (769) 264-7004
- Fax
- (866) 493-3926
- NPI assigned
- Oct 12, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ellen Denise Harris, DNP, FNP-BC
- Title
- Owner
- Phone
- (808) 724-0177
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
1081 Second St
Osyka, MS 39657-8076
Mailing address
PO Box 400
Osyka, MS 39657-0400
Phone (769) 264-7004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240305003391 | MS | Part B Supplier - Clinic/Group Practice | 0244675825 |
Receives reassigned benefits from 1 practitioner Practice locations: Osyka, MS |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697068800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1735862400000",
"number": "1316728512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 400",
"city": "OSYKA",
"state": "MS",
"postal_code": "396570400",
"telephone_number": "769-264-7004",
"fax_number": "866-493-3926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1081 SECOND ST",
"city": "OSYKA",
"state": "MS",
"postal_code": "396578076",
"telephone_number": "769-264-7004",
"fax_number": "866-493-3926"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COLLABORATIVENP HEALTH CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-10-12",
"last_updated": "2025-01-03",
"certification_date": "2025-01-03",
"status": "A",
"authorized_official_last_name": "HARRIS",
"authorized_official_first_name": "ELLEN",
"authorized_official_middle_name": "DENISE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "808-724-0177",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DNP, FNP-BC"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Osyka, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.