Individual provider Active NPI

Anne Romig Tucker, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1790952950
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R864139 Issued in MS
Practice address
4500 13TH St
Gulfport, MS 39501-2515
Phone
(228) 539-4141
Fax
(228) 832-3364
NPI assigned
May 15, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X R864139 MS
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R864139 MS Primary

Addresses

Primary practice location

4500 13TH St
Gulfport, MS 39501-2515

Mailing address

PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 867-5202

Other identifiers 1

IdentifierTypeStateIssuer
08189239MedicaidMS

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080910000016 MS Practitioner - Nurse Practitioner 6608942925 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R864139MSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
TBD Acquisition II LLC Current Accepting new patients
TBD Acquisition II, LLC CurrentSince Jul 9, 2018 Accepting new patients

Locations

11150 Highway 49
Gulfport, MS 39503
Phone (228) 575-1000

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1790952950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395021810",
            "telephone_number": "228-867-5202",
            "fax_number": "228-867-5007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 13TH ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012515",
            "telephone_number": "228-539-4141",
            "fax_number": "228-832-3364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "ANNE",
        "middle_name": "ROMIG",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-15",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MS",
            "license": "R864139",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "R864139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08189239",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.