Primary and Behavioral Healthcare Services, PA

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

PRIMARY AND BEHAVIORAL HEALTHCARE SERVICES, PA

Practice address

717 E. Fortification St.
Jackson, MS 39202-2402

Phone

(769) 572-4009

Fax

(769) 572-4021

NPI assigned

May 29, 2019

Organization subpart

No

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

Authorized official

Name

Shameca L Hudson, DNP, FNP-BCNPI 1619362977

Title

Chief Executive Officer

Phone

(769) 572-4009

Specialties & licenses 2

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS, VA2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Primary and Behavioral Healthcare Services, PA

  • Mental Health Counselor
  • Jackson, MS
  • NPI 1679135982

  O20191001000120

  Same enrollment

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shameca Hudson, DNP, FNP-BC,PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Jackson, MS
  • NPI 1619362977

  VA

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1710545488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 E. FORTIFICATION ST.",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022402",
            "telephone_number": "769-572-4009",
            "fax_number": "769-572-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 E. FORTIFICATION ST.",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022402",
            "telephone_number": "769-572-4009",
            "fax_number": "769-572-4021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2252 Tower Dr Ste 108",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712015765",
            "country_code": "US",
            "telephone_number": "769-572-4009",
            "fax_number": "769-572-4021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIMARY AND BEHAVIORAL HEALTHCARE SERVICES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-29",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "SHAMECA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "769-572-4009",
        "authorized_official_credential": "DNP, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005486078",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679135982",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710545488",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00000000",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "858885",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@pbhsms.org",
            "affiliation": "N",
            "endpointDescription": "credentialing email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "717 E Fortification St",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392022402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kwanza Ayanna Price, MSN, RN, PMHNP-BC
• Lauren Price, DO
• Wanya Pridgen
• Da'Sha S Priest, CMHT
• Primary and Behavioral Healthcare Services, PA
• Linda Dillon Primous, LMSW
• Allison Leigh Princiotta, CPNP-PC
• Jonathan Princiotta
• Isabelle Ann Prine
• Benita Pringle Ervin

• Psychiatric/Mental Health Nurse Practitioner in Jackson, MS
• Providers in Jackson, 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 Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.