Moniqua Shantal Tillman, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

33202 Issued in MS

Practice address

11150 US 49
Gulfport, MS 39503

Phone

(228) 831-1700

NPI assigned

Apr 12, 2019

Last updated

Mar 11, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

University of Mississippi School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Behavioral Health IncGroup PAC ID 7416194113, 109 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Integrated Behavioral Health, Inc.

  • Psychiatry Physician
  • Madison, AL
  • NPI 1730522699

  Child & Adolescent Psychiatry, MS

  Medicare reassignment Care Compare group NPD
• TBD Acquisition II LLC

  dba Gulfport Behavioral Health System

  • Psychiatric Hospital
  • Gulfport, MS
  • NPI 1750891792
  Medicare reassignment NPD
• TBD Acquisition II, LLC

  dba Gulfport Behavioral Health System

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1003324419
  NPD

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

{
    "created_epoch": "1555027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773187200000",
    "number": "1568925816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 TUCKER DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390425019",
            "telephone_number": "601-622-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11150 US 49",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39503",
            "telephone_number": "228-831-1700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2740 Pass Rd",
            "address_purpose": "LOCATION",
            "city": "Biloxi",
            "state": "MS",
            "postal_code": "395312626",
            "country_code": "US",
            "telephone_number": "228-276-1860",
            "fax_number": "256-429-9411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "MONIQUA",
        "middle_name": "SHANTAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-12",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MS",
            "license": "33202",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "AL",
            "license": "MD.42141",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thrive Counseling, PLLC
• Laura T. Throop, CTRS
• Thweatt Advanced Behavior Associates
• Richard Tilley, M.D.
• Justin Ross Tillman, FNP
• Jaci Tilman
• Rupesh Timilsina
• Jeffrey P Tipton, NP
• Raymond E. Tipton Jr., M.D.
• Hrishita Tiwari

• Child & Adolescent Psychiatry Physician in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Child & Adolescent Psychiatry Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.