Individual provider Active NPI

Tamatha Nicole Owen

  • Nurse Practitioner
  • Forest, MS
National Provider Identifier
1467095927
Registry record updated Oct 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
903572 Issued in MS
Practice address
1061 Highway 35 S
Forest, MS 39074
Phone
(931) 253-1110
NPI assigned
Oct 28, 2019
Last updated
Oct 28, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 903572 MS Primary

Addresses

Primary practice location

1061 Highway 35 S
Forest, MS 39074

Mailing address

PO Box 1258
Waynesboro, TN 38485-1258
Phone (931) 253-1110

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
I20191115000095 MS Practitioner - Nurse Practitioner 4082046917 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uppal Medical Center LLCGroup PAC ID 4587998547, 129 clinicians
Fast Pace Mississippi PLLCGroup PAC ID 3678832029, 192 clinicians
MDB Behavioral Health Services LLCGroup PAC ID 0749572915, 201 clinicians

Practice addresses (Care Compare)

1727 E Union St
Greenville, MS 38703-3253
Phone (662) 537-4830

1806 Simpson Hwy 49
Magee, MS 39111-5391
Phone (601) 439-1420

1911 Mission
66 Suite B
Vicksburg, MS 39180-3762
Phone (601) 456-2598

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
903572MSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Heal All Wound Care LLC CurrentSince Nov 1, 2025 Accepting new patients
MDB Care Management LLC CurrentSince Nov 1, 2025 Accepting new patients
Upperline Healthcare, PC CurrentSince Sep 22, 2025 Accepting new patients
Minor Med Care, LLC CurrentSince Nov 1, 2025 Accepting new patients
Fast Pace Mississippi, PLLC Nurse Practitioner CurrentSince Oct 1, 2019 Accepting new patients
Upperline Healthcare, PC Nurse Practitioner CurrentSince Sep 22, 2025 Accepting new patients
Uppal Medical Center LLC CurrentSince Nov 1, 2025 Accepting new patients
Minor Med Care, LLC CurrentSince Nov 1, 2025 Accepting new patients
MDB Behavioral Health Services LLC CurrentSince Nov 1, 2025 Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince Oct 1, 2019 Accepting new patients
Heal All Wound Care LLC PastSince Nov 1, 2025 Accepting new patients

Locations

660 Lakeland East Dr
Ste 210
Flowood, MS 39232
Phone (601) 664-4162

1061 Highway 35 S
Forest, MS 39074
Phone (601) 541-4310

1727 E Union St
Greenville, MS 38703
Phone (662) 332-0373

7 Professional Pkwy
Ste 101
Hattiesburg, MS 39402
Phone (601) 781-1661

215 Katherine Dr
#A
Jackson, MS 39232

2860 McDowell Road Ext
Jackson, MS 39204
Phone (601) 372-1117

1806 Simpson Highway 49
Magee, MS 39111
Phone (601) 439-1420

517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206

Organizations & group practices 11

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": "1572220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1467095927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1258",
            "city": "WAYNESBORO",
            "state": "TN",
            "postal_code": "384851258",
            "telephone_number": "931-253-1110",
            "fax_number": "256-664-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 HIGHWAY 35 S",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "39074",
            "telephone_number": "931-253-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWEN",
        "first_name": "TAMATHA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-28",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "903572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, MS

Sources for this page

Verify at the official NPI Registry.