Individual provider Active NPI

Angela Denise Dearman

  • Family Nurse Practitioner
  • Laurel, MS
National Provider Identifier
1326655168
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
904408 Issued in MS
Practice address
811 N 2ND Ave
Laurel, MS 39440-3561
Phone
(601) 466-9921
NPI assigned
Sep 25, 2020
Last updated
Jun 30, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 904408 MS Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

811 N 2ND Ave
Laurel, MS 39440-3561

Mailing address

811 N 2ND Ave
Laurel, MS 39440-3561
Phone (601) 466-9921

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210517002273 MS Practitioner - Nurse Practitioner 5799194031 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pain Consultants of South Mississippi PAGroup PAC ID 8628015369, 2 clinicians

Practice addresses (Care Compare)

106 Asbury Cir
Hattiesburg, MS 39402-1302
Phone (601) 268-8698

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
904408MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grayson Creek Medical Clinic, LLC Family CurrentSince Apr 30, 2021 Accepting new patients
Smith Audiology, LLC CurrentSince Nov 24, 2024 Accepting new patients
Pain Consultants of South Mississippi PA CurrentSince Sep 1, 2024 Accepting new patients
Arden Health LLC Family Current Accepting new patients

Locations

106 Asbury Cir
Hattiesburg, MS 39402
Phone (601) 264-6283

3 John Everett Rd
Moselle, MS 39459
Phone (601) 475-9304

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1326655168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 N 2ND AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394403561",
            "telephone_number": "601-466-9921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 N 2ND AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394403561",
            "telephone_number": "601-466-9921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEARMAN",
        "first_name": "ANGELA",
        "middle_name": "DENISE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-25",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904408",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.