Crystal Jo Nichols, C.F.N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R870294 Issued in MS

Practice address

285 Ivie LN
Mantachie, MS 38855-9764

Phone

(662) 282-4197

Fax

(662) 282-5121

NPI assigned

Oct 15, 2010

Last updated

Oct 23, 2014By 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 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mantachie Rural Health Care, IncGroup PAC ID 2567372121, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Tupelo, MS, CCN 257303
• North Mississippi Medical Ctr HHA Home health agency, Tupelo, MS, CCN 257002
• North Mississippi Medical Center Hospital, Tupelo, MS, CCN 250004

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IIBHBA

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.

• Mantachie Rural Health Care, Inc

  dba Mantachie Clinic

  • Family Medicine Physician
  • Mantachie, MS
  • NPI 1033169545
  Medicare reassignment Care Compare group NPD
• Community Family Healthcare, Inc

  • Family Nurse Practitioner
  • Mantachie, MS
  • NPI 1891907093
  Medicare reassignment NPD
• Mantachie Rural Health Care, Inc

  dba Dorsey Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Fulton, MS
  • NPI 1508652330
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Gilbert's Home Health Agency, Inc.

  dba CenterWell Home Health

  • Home Health Agency
  • Tupelo, MS
  • NPI 1972509099
  Care Compare affiliation
• North Mississippi Medical Center, Inc.

  dba North MS Medical Center Home Health Agency

  • Home Health Agency
  • Tupelo, MS
  • NPI 1003871344
  Care Compare affiliation
• North Mississippi Medical Center, Inc.

  dba North Mississippi Medical Center

  • General Acute Care Hospital
  • Tupelo, MS
  • NPI 1598875460
  Care Compare affiliation

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

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414022400000",
    "number": "1659681328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 IVIE LN",
            "city": "MANTACHIE",
            "state": "MS",
            "postal_code": "388559764",
            "telephone_number": "662-282-4197",
            "fax_number": "662-282-4197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 IVIE LN",
            "city": "MANTACHIE",
            "state": "MS",
            "postal_code": "388559764",
            "telephone_number": "662-282-4197",
            "fax_number": "662-282-5121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "CRYSTAL",
        "middle_name": "JO",
        "credential": "C.F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-15",
        "last_updated": "2014-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R870294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05372791",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mantachie Rural Health Care, Inc
• Mantachie Rural Health Care, Inc (Mantachie Rural Health Care Inc Behavioral Health)
• Mantachie Rural Health Care, Inc (Mantachie Rural Health Care, Inc. Mobile Unit)
• Mantachie Rural Health Care, Inc. Dental
• Susan Long Newell
• Trinity K Nichols, PHARMD
• Pro PT (Pro Therapy)
• Cynthia Smith, FNP
• Johnathon Crawford Smith Sr., CLPN
• Kristi Diann Smith, MSN, FNP-C

• Family Nurse Practitioner in Mantachie, MS
• Providers in Mantachie, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; 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.