Providence Wellness, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

PROVIDENCE WELLNESS, LLC

Practice address

4490 Highway 80 E Ste a
Pearl, MS 39208-4206

Phone

(601) 335-8600

Fax

(240) 219-3126

NPI assigned

Dec 5, 2024

Organization subpart

No

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

Authorized official

Name

Barbara L Tapps, NURSE PRACTITIONERNPI 1316158900

Title

Ceo Owner

Phone

(601) 955-4039

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Barbara L Tapps, FNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Pearl, MS
  • NPI 1316158900

  Family

  Medicare reassignment NPD Authorized official
• Nashamba Jackson-Bracey, FNP-C

  • Family Nurse Practitioner
  • Pearl, MS
  • NPI 1558812263
  NPD (past)

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

{
    "created_epoch": "1733356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1548076490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 GRAND OAK BLVD",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390566040",
            "telephone_number": "601-955-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4490 HIGHWAY 80 E STE A",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392084206",
            "telephone_number": "601-335-8600",
            "fax_number": "240-219-3126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-05",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "TAPPS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO OWNER",
        "authorized_official_telephone_number": "601-955-4039",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Pearl, MS
• Providers in Pearl, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.