NPIMap

Organization Active NPI

Mysti Blu LLC

  • Infusion Therapy Clinic/Center
  • Carrollton, TX
National Provider Identifier
1831915354
Registry record updated Nov 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X
Legal business name
MYSTI BLU LLC
Practice address
2459 E Hebron Pkwy Ste 130
Carrollton, TX 75010-4477
Phone
(972) 522-9799
Fax
(469) 546-9723
NPI assigned
Nov 30, 2024
Last updated
Nov 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2024

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

Authorized official

Name
Jerria Bernestine, FNP-CNPI 1578024931
Title
Owner
Phone
(972) 522-9799

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Home Infusion Agency 251F00000X NU
Infusion Therapy Clinic/Center 261QI0500X NU Primary
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

2459 E Hebron Pkwy Ste 130
Carrollton, TX 75010-4477

Mailing address

2459 E Hebron Pkwy Ste 130
Carrollton, TX 75010-4477
Phone (972) 522-9799

National Provider Directory

National Provider Directory
Tax ID family
IV Better Hydration Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1732924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732924800000",
    "number": "1831915354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2459 E HEBRON PKWY STE 130",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104477",
            "telephone_number": "972-522-9799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2459 E HEBRON PKWY STE 130",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104477",
            "telephone_number": "972-522-9799",
            "fax_number": "469-546-9723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTI BLU LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-30",
        "last_updated": "2024-11-30",
        "certification_date": "2024-11-30",
        "status": "A",
        "authorized_official_last_name": "BERNESTINE",
        "authorized_official_first_name": "JERRIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-522-9799",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.