NPIMap

Individual provider Active NPI

Colleen McMahon

  • Psychiatric/Mental Health Nurse Practitioner
  • Diamondhead, MS
National Provider Identifier
1922559012
Registry record updated Oct 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
901814 Issued in MS
Practice address
7826 Koko PL
Diamondhead, MS 39525-3624
Phone
(228) 324-0974
NPI assigned
Oct 24, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 901814 MS Primary

Addresses

Primary practice location

7826 Koko PL
Diamondhead, MS 39525-3624

Mailing address

7826 Koko PL
Diamondhead, MS 39525-3624
Phone (228) 324-0974

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170530000368 MS Practitioner - Nurse Practitioner 8123395944 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primesource Nursing Services, IncGroup PAC ID 7113966037, 5 clinicians
Safe Harbor Clinic LLCGroup PAC ID 1759615693, 6 clinicians

Practice addresses (Care Compare)

370 Courthouse Rd
Suite 106
Gulfport, MS 39507-1889
Phone (228) 865-1330

4013 Beatline Rd
Suite a
Long Beach, MS 39560-4135
Phone (228) 200-0720

Hospital & facility affiliations

  • Memorial Hospital at Gulfport Hospital, Gulfport, MS, CCN 250019
  • Highland Community Hospital Hospital, Picayune, MS, CCN 250117

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
901814MSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Safe Harbor Clinic LLC CurrentSince Nov 1, 2021 Accepting new patients
Changing Minds, LLC Current Accepting new patients
North Plantation PastSince Jul 24, 2022 Accepting new patients

Locations

4013 Beatline Rd
#A
Long Beach, MS 39560
Phone (228) 200-0720

Organizations & group practices 5

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.

Hospital & facility affiliations 61

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477267200000",
    "number": "1922559012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7826 KOKO PL",
            "city": "DIAMONDHEAD",
            "state": "MS",
            "postal_code": "395253624",
            "telephone_number": "228-324-0974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7826 KOKO PL",
            "city": "DIAMONDHEAD",
            "state": "MS",
            "postal_code": "395253624",
            "telephone_number": "228-324-0974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMAHON",
        "first_name": "COLLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-24",
        "last_updated": "2016-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "901814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Diamondhead, MS

Sources for this page

Verify at the official NPI Registry.