Mysti Blu LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

MYSTI BLU LLC

Practice address

2459 E. Hebron Parkway
#130
Carrollton, TX 75010

Phone

(972) 522-9799

Fax

(469) 546-9723

NPI assigned

Jun 14, 2023

Organization subpart

No

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

Authorized official

Name

Jerria Bernestine, FNPNPI 1578024931

Title

Owner

Phone

(972) 522-9799

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

IV Better Hydration Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mysti Blu LLC

  • Infusion Therapy Clinic/Center
  • Carrollton, TX
  • NPI 1831915354
  NPD tax ID

Practitioners 1

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

• Jerria Bernestine, FNP

  • Family Nurse Practitioner
  • Carrollton, TX
  • NPI 1578024931
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1609550219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 PRESTON ROAD",
            "address_2": "#300",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "75034",
            "telephone_number": "972-522-9799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2459 E. HEBRON PARKWAY",
            "address_2": "#130",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "75010",
            "telephone_number": "972-522-9799",
            "fax_number": "469-546-9723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTI BLU LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-14",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "BERNESTINE",
        "authorized_official_first_name": "JERRIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-522-9799",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Duane Myer, D.P.M.
• Jennifer Guadalupe Myers, DC
• Kevin R Myers, MD
• Miranda Myers
• Mysmile Dentistry PLLC
• Mysti Blu LLC
• Mysti Blu Management Group, LLC
• Mysti Blu Nursing, Inc.
• Mystic Smiles Children and Adult Dentistry
• N. Dike D.O Professional Association

• Infusion Therapy Clinic/Center in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Infusion Therapy Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.