NPIMap

Individual provider Active NPI

Lauren Sullivan

  • Psychiatric/Mental Health Nurse Practitioner
  • Biloxi, MS
National Provider Identifier
1366988230
Registry record updated Feb 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
901959 Issued in MS
Practice address
180 Debuys Rd
Biloxi, MS 39531-4402
Phone
(228) 669-0662
NPI assigned
Jan 16, 2017
Last updated
Feb 9, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 901959 MS Primary
Registered Nurse 163W00000X 885877 MS

Addresses

Primary practice location

180 Debuys Rd
Biloxi, MS 39531-4402

Mailing address

10947 Waterside Dr
Gulfport, MS 39503-6058
Phone (228) 669-0662

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170601000064 MS Practitioner - Nurse Practitioner 7113294810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindful MattersGroup PAC ID 7911287305, 6 clinicians

Practice addresses (Care Compare)

1613 23Rd Ave
Gulfport, MS 39501-2960
Phone (228) 284-4651

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
885877MSMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
North Plantation CurrentSince Jul 24, 2022 Accepting new patients

Locations

1613 23rd Ave
Gulfport, MS 39501
Phone (228) 284-4651

Organizations & group practices 2

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 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1484524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486598400000",
    "number": "1366988230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10947 WATERSIDE DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395036058",
            "telephone_number": "228-669-0662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 DEBUYS RD",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395314402",
            "telephone_number": "228-669-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "LAUREN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-16",
        "last_updated": "2017-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "901959",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "885877",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Biloxi, MS

Sources for this page

Verify at the official NPI Registry.