Mindfull, P. a.
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Florence, MS
NPI 1962050310 · NPPES record last updated Oct 13, 2022
Key facts
- NPI
- 1962050310
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- Legal business name
- MINDFULL, P. A.
- Practice address
- 1776 Highway 49 S
Florence, MS 39073-9429 - Phone
- (601) 825-6010
- Fax
- (601) 825-7146
- NPI assigned
- Aug 29, 2019
- Organization subpart
- No
Authorized official
- Name
- Roxian H Odom, PMHNP-BC
- Title
- Owner
- Phone
- (601) 825-6010
Practitioners 5
-
Roxian H Odom, PMHNP-BC
-
Ashley Melancon Prewitt, PMHNP
-
Christina Renee Bellisario, PMHNP-BC
-
Sally Day Sharp, PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200526002232 | MS | Part B Supplier - Clinic/Group Practice | 3678994803 |
Receives reassigned benefits from 3 practitioners Practice locations: Florence, MS |
National Provider Directory
Locations
201 N College St
Ste 105
Brandon, MS 39042
Phone (601) 825-6010
1776 Highway 49 S
Florence, MS 39073
Phone (601) 825-6010
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | Yes |
Addresses
Primary practice location
1776 Highway 49 S
Florence, MS 39073-9429
Mailing address
1776 Highway 49 S
Florence, MS 39073-9429
Phone (601) 825-6010
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04309701 | Medicaid | MS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Valant | Direct |
Other providers in Florence, MS
- Kelley N Martin
- Tynesha Deanna Martin
- Latonya Jaton McGowan
- Franklin Allen McKeown
- Tyler R McManus
- Mobility Benefit, LLC
- More Than Help Healthcare Services LLC
- Cecile Irene Morvan
- Charisse N. Myers
- Roxian H Odom
All providers in Florence, MS · Psychiatric/Mental Health 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 Oct 13, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.