Marly Jill Davis, NP
Individual provider Active NPI Nurse Practitioner · Wiggins, MS
NPI 1801568639 · NPPES record last updated Sep 30, 2021
Key facts
- NPI
- 1801568639
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 904775 (MS)
- Practice address
- 1440 Central Ave E
Wiggins, MS 39577-9602 - Phone
- (601) 928-6700
- Fax
- (601) 928-6731
- NPI assigned
- Sep 30, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 62
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Medical Systems Management, LLC
Memorial Hospital at Gulfport
Behavioral Consultant Solutions, LLC
Practice addresses (Care Compare)
129 Ctr St
Suite B
Richland, MS 39218-4800
Phone (769) 233-7141
1440 Central Ave E
Wiggins, MS 39577-9602
Phone (601) 928-6700
4 Erlene Watts Rd
Richton, MS 39476-9113
Phone (601) 408-0719
Hospital & facility affiliations
- Vitalcaring Group
- Deaconess Homecare- Region I
- Memorial Hospital at Gulfport
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211021000675 | MS | Practitioner - Nurse Practitioner | 8820486079 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 904775 | MS | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Systems Management LLC | Current |
Accepting new patients | |
| Memorial Hospital at Gulfport | Current |
Accepting new patients | |
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Current |
Accepting new patients | |
| Behavioral Consultant Solutions, LLC | Current |
Accepting new patients |
Locations
313 Abbey Ct
Biloxi, MS 39531
1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856
129 Center St
Ste B
Richland, MS 39218
Phone (769) 233-7141
105 N Front St
Richton, MS 39476
Phone (601) 788-2599
4 Erlene Watts Rd
Richton, MS 39476
1440 Central Ave E
Wiggins, MS 39577
Phone (601) 296-2100
Interoperability endpoints
- marly.davis@direct.mhg.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 904775 | MS | Yes |
Addresses
Primary practice location
1440 Central Ave E
Wiggins, MS 39577-9602
Mailing address
PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 575-1194
Other providers in Wiggins, MS
- Ray L Cooley
- Cornerstone Chiropractic PLLC
- Erin Couey
- Rebecca Cooley Courtney
- Kelli Anne Cruthirds
- Dental Group of Wiggins
- Donald Robert Doran Jr.
- Drayer Physical Therapy Institute LLC
- Drayer Physical Therapy Mississippi LLC
- DSG Enterprises
All providers in Wiggins, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.