Shasta Pickens

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

907092 Issued in MS

Practice address

117 S 11TH Ave
Laurel, MS 39440-4312

Phone

(601) 425-3033

Fax

(601) 422-0693

NPI assigned

Sep 26, 2022

Last updated

Jan 14, 2025By 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 2

Addresses

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Health Center, IncGroup PAC ID 9638163348, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Family Health Center, Inc

  • Clinic/Center
  • Laurel, MS
  • NPI 1760488357
  Medicare reassignment Care Compare group NPD
• Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Ellisville, MS
  • NPI 1083255087
  NPD
• Family Health Center, Inc

  dba Sandersville Clinic

  • Community Health Worker
  • Sandersville, MS
  • NPI 1578744900
  NPD
• Family Health Center, Inc

  dba Family Health Center/Taylorsville

  • Specialist
  • Taylorsville, MS
  • NPI 1154502979
  NPD (past)

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1679297436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 S 11TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404312",
            "telephone_number": "601-425-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 S 11TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404312",
            "telephone_number": "601-425-3033",
            "fax_number": "601-422-0693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKENS",
        "first_name": "SHASTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2025-01-14",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "907092",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MS",
            "license": "907223",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Peterson, SLP
• Ladonna Michelle Phillips, FNP
• Susan Lea Phillips, PTA
• Gail Phipps, NP
• Paul W Pickard, M.D.
• Paul J. Pickering Jr., DDS
• Joel Hudson Pierce, MPT
• Vivien Pierce, NP
• L. Cameron Pimperl, M.D.
• Terry Pitts, DO

• Family Nurse Practitioner in Laurel, MS
• Providers in Laurel, 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 Jan 14, 2025; 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.