Tanisha Martin
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Southaven, MS
NPI 1649753161 · NPPES record last updated Sep 11, 2018
Key facts
- NPI
- 1649753161
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 902907 (MS)
- Practice address
- 8626 Airways Blvd
Southaven, MS 38671-2603 - Phone
- (662) 832-0302
- NPI assigned
- Sep 11, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Uppal Medical Center LLC
MDB Behavioral Health Services LLC
Northeast Mental Health-Mental Retardation Commission
Practice addresses (Care Compare)
1727 E Union St
Greenville, MS 38703-3253
Phone (662) 537-4830
1911 Mission
66 Suite B
Vicksburg, MS 39180-3762
Phone (601) 456-2598
2434 S Eason Blvd
Tupelo, MS 38804-6942
Phone (662) 640-4595
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 |
|---|---|---|---|---|
| I20181101001967 | MS | Practitioner - Nurse Practitioner | 9032462437 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Uppal Medical Center LLC | Current |
Accepting new patients | |
| Minor Med Care, LLC | Current |
Accepting new patients | |
| Minor Med Care, LLC | Current |
Accepting new patients | |
| Northeast Mental Health-Mental Retardation Commission | Current |
Accepting new patients | |
| Northeast Mental Health/Mental Retardation Commission | Current |
Accepting new patients | |
| Be Mindful LLC | Psychiatric/Mental Health | Current | Accepting new patients |
| Northeast Mental Health-Mental Retardation Commission | Current | Accepting new patients |
Locations
1727 E Union St
Greenville, MS 38703
Phone (662) 332-0373
215 Katherine Dr
#A
Jackson, MS 39232
2860 McDowell Road Ext
Jackson, MS 39204
Phone (601) 372-1117
2434 S Eason Blvd
Tupelo, MS 38804
Phone (662) 640-4595
499 Gloster Creek Vlg
Ste A3
Tupelo, MS 38801
Phone (662) 640-4595
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 902907 | MS | Yes |
Addresses
Primary practice location
8626 Airways Blvd
Southaven, MS 38671-2603
Mailing address
108 Bailey Patricia Ave
Oxford, MS 38655-7336
Phone (662) 832-0302
Other providers in Southaven, MS
- Madiha Maqsood
- Marilyn M Kerr, LPC, LLC
- Jessica Joslin Martin
- Mary Karen Martin
- Paul Timothy Martin
- Jonathan Andrew Martinez
- Massage on Da Go LLC
- Massage Therapy Worx
- Cara Yvonne Massey
- Master Minds Dyslexia Center, LLC
All providers in Southaven, 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 Sep 11, 2018. 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.