Charles Nickolas Burns, RN, MSN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Brookhaven, MS
NPI 1497614952 · NPPES record last updated Jan 20, 2026
Key facts
- NPI
- 1497614952
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 918627 (MS)
- Practice address
- 545 Brookway Blvd
Brookhaven, MS 39601-3266 - Phone
- (601) 833-5255
- NPI assigned
- Jan 20, 2026
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Extended Care Clinical Services, LLC
Practice addresses (Care Compare)
545 Brookway Blvd
Brookhaven, MS 39601-3266
Phone (601) 833-5255
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 |
|---|---|---|---|---|
| I20260305002200 | MS | Practitioner - Nurse Practitioner | 0547742843 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 918627 | MS | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Extended Care Clinical Services LLC | Current |
Accepting new patients |
Locations
545 Brookway Blvd
Brookhaven, MS 39601
Phone (601) 748-8153
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 918627 | MS | Yes |
Addresses
Primary practice location
545 Brookway Blvd
Brookhaven, MS 39601-3266
Mailing address
545 Brookway Blvd
Brookhaven, MS 39601-3266
Phone (601) 833-5255
Other providers in Brookhaven, MS
- Stacy Maurice Brown
- Anna Catherine Bruce
- Shana M Brumfield Lewis
- Carol A Buckels
- Michael Burch
- Kimberly Burr
- Makieta Byrd
- Shanijua E Byrd
- Steven Wilson Cabell
- Bryan S Calcote
All providers in Brookhaven, MS · Psychiatric/Mental Health 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 Jan 20, 2026. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.