Organization Active NPI

Southern Light Mental Health, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Pontotoc, MS
National Provider Identifier
1609582501
Registry record updated Nov 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
SOUTHERN LIGHT MENTAL HEALTH, LLC
Practice address
12 Brookes Xing
Pontotoc, MS 38863-1009
Phone
(662) 489-4044
NPI assigned
Jan 25, 2023
Last updated
Nov 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2025

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

Authorized official

Name
Laurie Duncan
Title
Vice President of Revenue
Phone
(678) 332-6122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

12 Brookes Xing
Pontotoc, MS 38863-1009

Mailing address

206 Oxford Rd
New Albany, MS 38652-3115
Phone (662) 360-4018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240909000790 MS Part B Supplier - Clinic/Group Practice 8729528567 Receives reassigned benefits from 1 practitioner
Practice locations: Pontotoc, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763942400000",
    "number": "1609582501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 OXFORD RD",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386523115",
            "telephone_number": "662-360-4018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 BROOKES XING",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388631009",
            "telephone_number": "662-489-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN LIGHT MENTAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-25",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "VICE PRESIDENT OF REVENUE",
        "authorized_official_telephone_number": "678-332-6122"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontotoc, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 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.