Individual provider Active NPI

Madison Makenzie Gooch, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Southaven, MS
National Provider Identifier
1437978103
Registry record updated Dec 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
906996 Issued in MS
Practice address
8626 Airways Blvd
Southaven, MS 38671-2603
Phone
(662) 772-5937
Fax
(662) 772-5940
NPI assigned
Oct 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2025

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 906996 MS Primary

Addresses

Primary practice location

8626 Airways Blvd
Southaven, MS 38671-2603

Mailing address

8626 Airways Blvd
Southaven, MS 38671-2603
Phone (662) 772-5937

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
I20260113003660 MS Practitioner - Nurse Practitioner 2163908724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Desoto Family Counseling Center PLLCGroup PAC ID 1254511686, 11 clinicians

Practice addresses (Care Compare)

8626 Airways Blvd
Southaven, MS 38671-2603
Phone (662) 772-5937

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
906996MSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hec Medical Psychiatric/Mental Health CurrentSince Jan 12, 2025 Accepting new patients
Desoto Family Counseling Center PLLC CurrentSince Dec 1, 2025 Accepting new patients

Locations

311 E Main St
Senatobia, MS 38668
Phone (662) 772-5937

6858 Swinnea Rd
Bldg 7
Southaven, MS 38671
Phone (662) 510-8400

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.

NPI Registry JSON

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

{
    "created_epoch": "1728432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764979200000",
    "number": "1437978103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8626 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712603",
            "telephone_number": "662-772-5937",
            "fax_number": "662-772-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8626 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712603",
            "telephone_number": "662-772-5937",
            "fax_number": "662-772-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOCH",
        "first_name": "MADISON",
        "middle_name": "MAKENZIE",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-09",
        "last_updated": "2025-12-06",
        "certification_date": "2025-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "906996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.