Emily Roberts Aust, CFNP
Individual provider Active NPI Nurse Practitioner · Belzoni, MS
NPI 1851624928 · NPPES record last updated Sep 10, 2009
Key facts
- NPI
- 1851624928
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- R867435 (MS)
- Practice address
- 107 Church St.
Belzoni, MS 39038 - Phone
- (662) 247-2105
- Fax
- (662) 247-4849
- NPI assigned
- Sep 8, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
110 S MLK Jr Dr
Indianola, MS 38751-2622
Phone (662) 445-2213
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 |
|---|---|---|---|---|
| I20101124000609 | MS | Practitioner - Nurse Practitioner | 2668668054 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R867435 | MS | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revive Wellness and Aesthetics LLC | Current |
Accepting new patients | |
| Patients Choice Medical Center of Humphreys County, LLC | Past | Accepting new patients |
Locations
110A S Martin Luther King Jr Dr
Indianola, MS 38751
Phone (662) 445-2213
110 S Martin Luther King Jr Dr
#A
Indianola, MS 38751
110 S Martin Luther King Jr Dr
Indianola, MS 38751
Phone (662) 445-2213
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R867435 | MS | Yes |
Addresses
Primary practice location
107 Church St.
Belzoni, MS 39038
Mailing address
P.O. Box 633
Belzoni, MS 39038
Phone (662) 247-2105
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09014025 | Medicaid | MS |
Other providers in Belzoni, MS
- A & a Infusion & Specialty, LLC
- Arden Home Health of West Mississippi LLC
- Aspirations Adult Day Services LLC
- Mabry Lynne Bailey
- Heather M Barnes
- Wilfredo Bullock
- Camp Kidz LLC
- Camp Reloaded LLC
All providers in Belzoni, 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 10, 2009. 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.