Desiree Norman, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R872705 Issued in MS

Practice address

11150 Highway 49
MBH Outpatient Clinic
Gulfport, MS 39503-4110

Phone

(228) 575-1000

Fax

(228) 575-2002

NPI assigned

Nov 10, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Desiree Peterson Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• TBD Acquisition II LLC

  dba Gulfport Behavioral Health System

  • Psychiatric Hospital
  • Gulfport, MS
  • NPI 1750891792
  Medicare reassignment NPD
• TBD Acquisition II, LLC

  dba Gulfport Behavioral Health System

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1003324419
  NPD

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

{
    "created_epoch": "1415577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433116800000",
    "number": "1861898355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11150 HIGHWAY 49",
            "address_2": "MBH OUTPATIENT CLINIC",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034110",
            "telephone_number": "228-575-1000",
            "fax_number": "228-575-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11150 HIGHWAY 49",
            "address_2": "MBH OUTPATIENT CLINIC",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034110",
            "telephone_number": "228-575-1000",
            "fax_number": "228-575-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORMAN",
        "first_name": "DESIREE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-10",
        "last_updated": "2015-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "R872705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01858357",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESIREE",
            "last_name": "PETERSON",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.