Individual provider Active NPI

Pamela K Prince, FNP

  • Family Nurse Practitioner
  • Philadelphia, MS
National Provider Identifier
1376784058
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R780836 Issued in MS
Practice address
1001 Holland Ave
Philadelphia, MS 39350-2161
Phone
(601) 663-1341
NPI assigned
Mar 10, 2009
Last updated
Sep 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R780836 MS Primary

Addresses

Primary practice location

1001 Holland Ave
Philadelphia, MS 39350-2161

Mailing address

1001 Holland Ave
Philadelphia, MS 39350-2161
Phone (601) 663-1341

Other identifiers 1

IdentifierTypeStateIssuer
06253329MedicaidMS

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
I20110307000572 MS Practitioner - Nurse Practitioner 0840472262 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neshoba County General HospitalGroup PAC ID 6204738289, 30 clinicians

Practice addresses (Care Compare)

1001 Holland Ave
Philadelphia, MS 39350-2161
Phone (601) 663-1200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Neshoba County General Hospital CurrentSince Apr 1, 2012 Accepting new patients
Neshoba County General Hospital CurrentSince Apr 1, 2012 Accepting new patients
Neshoba County General Hospital Current Accepting new patients

Locations

1001 Holland Ave
Philadelphia, MS 39350
Phone (601) 663-1200

1056 Holland Ave
Philadelphia, MS 39350
Phone (601) 656-1465

Organizations & group practices 3

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 1

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": "1236643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1376784058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 HOLLAND AVE",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393502161",
            "telephone_number": "601-663-1341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 HOLLAND AVE",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393502161",
            "telephone_number": "601-663-1341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRINCE",
        "first_name": "PAMELA",
        "middle_name": "K",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-10",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R780836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06253329",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, MS

Sources for this page

Verify at the official NPI Registry.