Individual provider Active NPI

Tanya Sanderson, NP

  • Primary Care Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1457907248
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
903201 Issued in MS
Practice address
738 S Gloster St Ste B
Tupelo, MS 38801-4932
Phone
(662) 630-4005
NPI assigned
Aug 16, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 903201 MS Primary

Addresses

Primary practice location

738 S Gloster St Ste B
Tupelo, MS 38801-4932

Mailing address

738 S Gloster St Ste B
Tupelo, MS 38801-4932
Phone (662) 630-4005

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
I20210914001899 MS Practitioner - Nurse Practitioner 1951707140 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

990 S Madison St
Suite 2
Tupelo, MS 38801-6308
Phone (662) 377-3896

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medcial Center, Inc. CurrentSince Aug 31, 2021 Accepting new patients
North Mississippi Medical Center Inc Current Accepting new patients
North Mississippi Medical Clinics Inc CurrentSince Jul 20, 2022 Accepting new patients
North Mississippi Medical Center Inc CurrentSince Aug 31, 2021 Accepting new patients
North Mississippi Medical Center Current Accepting new patients
North Mississippi Medical Clinics Inc CurrentSince Jul 20, 2022 Accepting new patients
North Mississippi Medcial Center, Inc. Past Accepting new patients

Locations

4381 S Eason Blvd
Ste 302
Tupelo, MS 38801
Phone (662) 377-5700

845 S Madison St
Tupelo, MS 38801
Phone (601) 790-5025

990 S Madison St
#2
Tupelo, MS 38801
Phone (601) 844-9166

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

738 S Gloster St
Ste B
Tupelo, MS 38801
Phone (662) 377-3896

Interoperability endpoints

  • Direct secure messaging: tanyasanderson@nmhs.medalliesdirect.net

Organizations & group practices 7

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 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": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1457907248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "738 S GLOSTER ST STE B",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014932",
            "telephone_number": "662-630-4005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "738 S GLOSTER ST STE B",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014932",
            "telephone_number": "662-630-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "TANYA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-16",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "903201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.