Tina Denise McDyess, PHD

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

905967 Issued in MS

Practice address

5192 Highway 11 N
Ellisville, MS 39437-5050

Phone

(601) 479-4457

NPI assigned

Aug 24, 2022

Last updated

Jun 12, 2023By 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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Doctor of Philosophy

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.

• Inner Peace Mental Wellness Center

  • Psychiatric/Mental Health Nurse Practitioner
  • Newton, MS
  • NPI 1578430088
  Medicare reassignment NPD Authorized official
• Region 12 Commission on Mental Health & Retardation Pine Belt Men

  dba Pine Belt Mental Health Care Resources

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hattiesburg, MS
  • NPI 1982610572
  Medicare reassignment NPD

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1689393407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 BELMONT AVE",
            "city": "NEWTON",
            "state": "MS",
            "postal_code": "393452566",
            "telephone_number": "601-479-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5192 HIGHWAY 11 N",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394375050",
            "telephone_number": "601-479-4457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDYESS",
        "first_name": "TINA",
        "middle_name": "DENISE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-24",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "905967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jammie Marques
• Pamela McAndrews, IDD WAIVER SERVICES
• Katherine N McCardle
• Kathleen Frances McCoy, P.T.
• Audrey McCullum, CCSS
• Lacey Leigh McLaurin, M.S. R.D.
• Clarence Lee Middleton, RPH
• Tony Earl Miller, N.P.
• Tracie Miller, CCSS
• Mississippi State Department of Health

• Psychiatric/Mental Health Nurse Practitioner in Ellisville, MS
• Providers in Ellisville, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.