Phyllis Provost, APRN
Individual provider Active NPI Psychiatric/Mental Health Registered Nurse · Hauppauge, NY
NPI 1972656783 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1972656783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Registered Nurse 163WP0808X
- License
- 270668-1 (NY)
- Practice address
- 750 Veterans Hwy
Hauppauge, NY 11788-2943 - Phone
- (631) 724-5522
- Fax
- (631) 724-5546
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Certified Clinical Nurse Specialist (CNS)
- Education
- Other, 1975
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
146 Muirfield Rd
Rockville Centre, NY 11570-2732
Phone (516) 428-9721
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- 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 |
|---|---|---|---|---|
| I20100807000029 | NY | Practitioner - Certified Clinical Nurse Specialist (CNS) | 5496888794 | Practice locations: Rockville Centre, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 270668-1 | NY | MD | Psychiatric/Mental Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 270668-1 | NY | Yes |
Addresses
Primary practice location
750 Veterans Hwy
Hauppauge, NY 11788-2943
Mailing address
77 Ridge Rd
Southampton, NY 11968-3608
Phone (631) 724-5522
Other providers in Hauppauge, NY
- Professional Occupational & Physical Therapy, PLLC
- Professional Orthopedic and Sports Physical Therapy, PC
- Lauren Elizabeth Profeta
- Project Safety Net Ny, Inc
- John Francis Provost
- QC-Medi New York, Inc.
- Charline Queliz
- Donna Quinn
- Kimberly Quintero
- Jacqueline Iliana Quiros
All providers in Hauppauge, NY · Psychiatric/Mental Health Registered Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.