Individual provider Active NPI

Donald Allan Dearman, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Vicksburg, MS
National Provider Identifier
1679084024
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
215873 Issued in LA
Practice address
1911 Mission 66 Ste B
Vicksburg, MS 39180-3762
Phone
(601) 665-4162
NPI assigned
Oct 12, 2017
Last updated
Jul 27, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 902297 MS
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 215873 LA Primary

Addresses

Primary practice location

1911 Mission 66 Ste B
Vicksburg, MS 39180-3762

Mailing address

PO Box 18679
Hattiesburg, MS 39404-8679

Other practice location 1

103 S 19th Ave
Hattiesburg, MS 39401-6171
Phone (601) 544-4641

Other identifiers 1

IdentifierTypeStateIssuer
00026591MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, LA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20171229001789 MS Practitioner - Nurse Practitioner 9830457597 Reassigns benefits to 3 organizations
I20210309000398 LA Practitioner - Nurse Practitioner 9830457597 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minor Med Care, LLCGroup PAC ID 7618866021, shared by 2 NPIs, 77 clinicians
MDB Behavioral Health Services LLCGroup PAC ID 0749572915, 201 clinicians

Practice addresses (Care Compare)

120 W Main St
Raymond, MS 39154-1223
Phone (601) 857-2341

1911 Mission
Vicksburg, MS 39180-3762
Phone (601) 456-2598

214 E Railroad Ave
Palmetto, LA 71358-3500
Phone (800) 462-0742

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
902297MSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Region XII Commission CurrentSince Nov 13, 2017 Accepting new patients
MD Billing, LLC CurrentSince Mar 11, 2020 Accepting new patients
Region 12 Commission on Mental Health & Retardation Pine Belt Men CurrentSince Nov 13, 2017 Accepting new patients

Locations

501 Avalon Way
Ste D
Brandon, MS 39047

557 Grants Ferry Rd
Brandon, MS 39047
Phone (601) 207-2017

103 S 19th Ave
Hattiesburg, MS 39401
Phone (601) 544-4222

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1679084024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18679",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394048679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 MISSION 66 STE B",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803762",
            "telephone_number": "601-665-4162"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 S 19th Ave",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394016171",
            "country_code": "US",
            "telephone_number": "601-544-4641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEARMAN",
        "first_name": "DONALD",
        "middle_name": "ALLAN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-12",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "902297",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "LA",
            "license": "215873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00026591",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

Verify at the official NPI Registry.