Vicenda Augustin
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Southaven, MS
NPI 1811684335 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1811684335
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 7601 Southcrest Pkwy
Southaven, MS 38671-4742 - Phone
- (662) 772-4696
- NPI assigned
- Apr 24, 2023
- Sex
- Female
- Sole proprietor
- No
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: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230717002570 | MS | Order and Referring Only - Family Practice |
2466812847 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
7601 Southcrest Pkwy
Southaven, MS 38671-4742
Mailing address
7601 Southcrest Pkwy
Southaven, MS 38671-4742
Phone (662) 772-4696
Other providers in Southaven, MS
- Tabitha Flowers Arrington
- Karen Ashabranner
- Anthony Alan Ashbrook
- Linda Awung Asongayi
- Atlantic Medical, LLC
- Jennah Suzuko Avery-Morin
- Hany Imad Awad
- Mariam Sherif Awad
- Axon Surgical Center, PLLC
- Samantha Ayers
All providers in Southaven, MS · Student in an Organized Health Care Education/Training Program in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.