Doretha Bournes, NP
Individual provider Active NPI Family Nurse Practitioner · Monticello, MS
NPI 1487089546 · NPPES record last updated Sep 9, 2013
Key facts
- NPI
- 1487089546
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R858932 (MS)
- Practice address
- 354 Cub Brown Rd
Monticello, MS 39654-7505 - Phone
- (601) 587-4629
- NPI assigned
- Sep 9, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180626003304 | MS | Practitioner - Nurse Practitioner | 1052666435 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R858932 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Care Health Network LLC | Current |
Accepting new patients |
Locations
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
232 Market St
Jackson, MS 39232
Phone (588) 498-6767
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R858932 | MS | Yes |
Addresses
Primary practice location
354 Cub Brown Rd
Monticello, MS 39654-7505
Mailing address
354 Cub Brown Rd
Monticello, MS 39654-7505
Phone (601) 587-4629
Other providers in Monticello, MS
- Atwood Emergency Physicians LLC
- Bathsheba Nicole Badon
- Blake A. Ballard
- Bonita C. Musial
- Armanda L. Bourne
- Chris Gilbert Boyd
- Constance M. Bradford
- Brenco
- Bridges Professional Counseling and Consulting LLC
- Kelly Mackenzie Brister
All providers in Monticello, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.