Individual provider Active NPI

Rebekah N Stallworth, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Pascagoula, MS
National Provider Identifier
1376157487
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
903918 Issued in MS
Practice address
4502 LT Eugene J Majure Dr
Pascagoula, MS 39581-5305
Phone
(228) 696-9224
Fax
(228) 696-9228
NPI assigned
Sep 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 903918 MS Primary

Addresses

Primary practice location

4502 LT Eugene J Majure Dr
Pascagoula, MS 39581-5305

Mailing address

2101 Highway 90
Gautier, MS 39553-5340
Phone (228) 497-7576

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
I20201015000774 MS Practitioner - Nurse Practitioner 3971923806 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
Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians

Practice addresses (Care Compare)

4502 LT Eugene J Majure Dr
Coastal Ambulatory Services
Pascagoula, MS 39581-5305
Phone (228) 696-9224

Hospital & facility affiliations

  • Singing River Health System Hospital, Pascagoula, MS, CCN 250040
  • Singing River Gulfport Hospital, Gulfport, MS, CCN 250123

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Health System CurrentSince Oct 22, 2020 Accepting new patients
Singing River Gulfport CurrentSince Jun 3, 2024 Accepting new patients

Locations

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

4502 Lt Eugene J Majure Dr
Pascagoula, MS 39581
Phone (228) 696-9224

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1599177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1376157487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 HIGHWAY 90",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535340",
            "telephone_number": "228-497-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 LT EUGENE J MAJURE DR",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815305",
            "telephone_number": "228-696-9224",
            "fax_number": "228-696-9228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLWORTH",
        "first_name": "REBEKAH",
        "middle_name": "N",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-04",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "903918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pascagoula, MS

Sources for this page

Verify at the official NPI Registry.