Doretha Bournes, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R858932 Issued in MS

Practice address

354 Cub Brown Rd
Monticello, MS 39654-7505

Phone

(601) 587-4629

NPI assigned

Sep 9, 2013

Last updated

Sep 9, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Community Care Health Network LLC

  dba Matrix Medical Network

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  MS

  Medicare reassignment NPD

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

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378684800000",
    "number": "1487089546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 CUB BROWN RD",
            "city": "MONTICELLO",
            "state": "MS",
            "postal_code": "396547505",
            "telephone_number": "601-587-4629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 CUB BROWN RD",
            "city": "MONTICELLO",
            "state": "MS",
            "postal_code": "396547505",
            "telephone_number": "601-587-4629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURNES",
        "first_name": "DORETHA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-09",
        "last_updated": "2013-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R858932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Atwood Emergency Physicians LLC
• Bathsheba Nicole Badon, PMHNP-BC
• Blake A. Ballard, PTA
• Bonita C. Musial
• Armanda L. Bourne, PT
• Chris Gilbert Boyd, DMD
• Constance M. Bradford, FNP-C
• Brenco
• Bridges Professional Counseling and Consulting LLC
• Kelly Mackenzie Brister, COTA

• Family Nurse Practitioner in Monticello, MS
• Providers in Monticello, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.