Individual provider Active NPI

Stephanie P Myers, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1497150056
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
867360 Issued in MS
Practice address
2117 Broadway Dr
Hattiesburg, MS 39402-3210
Phone
(601) 288-8050
NPI assigned
Oct 24, 2014
Last updated
Jun 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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 867360 MS Primary

Addresses

Primary practice location

2117 Broadway Dr
Hattiesburg, MS 39402-3210

Mailing address

2117 Broadway Dr
Hattiesburg, MS 39402-3210
Phone (601) 288-8050

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
I20141218000795 MS Practitioner - Nurse Practitioner 9830412196 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forrest County General HospitalGroup PAC ID 1052397767, 107 clinicians

Practice addresses (Care Compare)

1 Lincoln Pkwy
Hattiesburg, MS 39402-3262
Phone (601) 288-8050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
867360MSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince Aug 1, 2022 Accepting new patients
Sumrall Family Health Center Current Accepting new patients
Forrest County General Hospital Family CurrentSince Aug 1, 2022 Accepting new patients
Forrest County General Hospital Current Accepting new patients
Hattiesburg High School Campus Clinic CurrentSince Sep 10, 2021 Accepting new patients

Locations

44 Brooklyn Janice Rd
Brooklyn, MS 39425
Phone (601) 582-1188

1 Lincoln Pkwy
Ste 202
Hattiesburg, MS 39402
Phone (601) 288-8050

2117 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-8050

66 Old Airport Rd
Hattiesburg, MS 39401
Phone (601) 544-7500

Organizations & group practices 5

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.

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": "1414108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1497150056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 BROADWAY DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023210",
            "telephone_number": "601-288-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 BROADWAY DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023210",
            "telephone_number": "601-288-8050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "STEPHANIE",
        "middle_name": "P",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-24",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "867360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.