Jennifer S Brechtel, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Gulfport, MS
NPI 1649370503 · NPPES record last updated Jan 27, 2010
Key facts
- NPI
- 1649370503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- R873301 (MS)
- Practice address
- 1600 Broad Ave
Gulfport, MS 39501-3603 - Phone
- (228) 863-1132
- Fax
- (228) 865-1700
- NPI assigned
- Sep 22, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Primesource Nursing Services, Inc
Practice addresses (Care Compare)
370 Courthouse Rd
Suite 106
Gulfport, MS 39507-1889
Phone (228) 865-1330
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 |
|---|---|---|---|---|
| I20100510000251 | MS | Practitioner - Nurse Practitioner | 9638179435 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C6737 | MS | MD | Marriage & Family Therapist |
| R873301 | MS | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primesource Nursing Services, Inc | Current | Accepting new patients | |
| Safe Harbor Clinic LLC | Current |
Accepting new patients | |
| Primesource Nursing Services, Inc | Psychiatric/Mental Health | Current |
Accepting new patients |
| Oceans Mississippi Medical Group LLC | Current |
Accepting new patients | |
| Coastal Family Health Center, Inc | Past | Accepting new patients | |
| Nursing Home Psychological Services of Mississippi, Inc. | Social Worker | Past | Accepting new patients |
| Nursing Home Psychological Services, LLC | Social Worker | Past | Accepting new patients |
Locations
152 Gateway Dr
Biloxi, MS 39531
Phone (228) 388-0600
180 Debuys Rd
Biloxi, MS 39531
Phone (228) 338-0220
180 Debuys Rd
#C
Biloxi, MS 39531
Phone (228) 388-0600
370 Courthouse Rd
Ste 106
Gulfport, MS 39507
4013 Beatline Rd
#A
Long Beach, MS 39560
Phone (228) 200-0720
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | C6737 | MS | |
| Marriage & Family Therapist | 106H00000X | C6737 | MS | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R873301 | MS | Yes |
Addresses
Primary practice location
1600 Broad Ave
Gulfport, MS 39501-3603
Mailing address
1600 Broad Ave
Gulfport, MS 39501-3603
Phone (228) 863-1132
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02309788 | Medicaid | MS |
Other providers in Gulfport, MS
- Branch Medical Clinic Gulfport
- David Ray Branch
- Clay Bratton
- Lindsey Bray
- Mundy Scott Breazeale Sr.
- Beth R Breland
- Deirdre Lee Breland
- Julianna Marie Breland
- Bhavati Brennan
- Lindsey Brennan
All providers in Gulfport, 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 27, 2010. 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.