Lekenya Miriam Nuttall, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

903390 Issued in MS

Practice address

415 US Highway 49 N
Tutwiler, MS 38963-5091

Phone

(662) 345-6567

NPI assigned

Sep 4, 2019

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

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 and National Provider Directory roles.

• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  MS

  Medicare reassignment NPD

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

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1710536636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 46",
            "city": "RULEVILLE",
            "state": "MS",
            "postal_code": "387710046",
            "telephone_number": "662-402-2351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 US HIGHWAY 49 N",
            "city": "TUTWILER",
            "state": "MS",
            "postal_code": "389635091",
            "telephone_number": "662-345-6567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUTTALL",
        "first_name": "LEKENYA",
        "middle_name": "MIRIAM",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-04",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "903390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiny Hospice Palliative Care Specialty Sercices Inc
• Pattye Dorris, AGNP
• Sabrina Gail Easter, APRN
• Barbara Henry
• Devona L'Tanya Jones, LPC
• Maria Luisa Ozua, FNP
• Parental Adult Daycare
• Select Choice Adult Day Care, LLC
• Nawal Singh Shekhawat, M.D.
• Tkeyah Snerling

• All providers in Tutwiler, MS
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; 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.