Carly O'Neal, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Booneville, MS
NPI 1992286777 · NPPES record last updated Aug 28, 2018
Key facts
- NPI
- 1992286777
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 902870 (MS)
- Practice address
- 2100 E Chambers Dr
Booneville, MS 38829-8938 - Phone
- (662) 286-9883
- NPI assigned
- Aug 28, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mantachie Rural Health Care, Inc
Practice addresses (Care Compare)
5681 Hwy 363
Mantachie, MS 38855-7632
Phone (662) 282-4226
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 |
|---|---|---|---|---|
| I20181016001951 | MS | Practitioner - Nurse Practitioner | 1557613775 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Region IV Mental Health | Current |
Accepting new patients | |
| Region IV Mental Health Services | Current | Accepting new patients | |
| Region IV Desoto County Pharmacy | Current |
Accepting new patients |
Locations
2100 E Chambers Dr
Booneville, MS 38829
Phone (662) 728-3137
601 Foote St
Corinth, MS 38834
Phone (662) 287-4424
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 902870 | MS | Yes |
Addresses
Primary practice location
2100 E Chambers Dr
Booneville, MS 38829-8938
Mailing address
112 Englewood CV
Saltillo, MS 38866-8725
Phone (662) 397-4574
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 902870 | Other | MS | PMHNP |
Other providers in Booneville, MS
- Northeast Mississippi Community Services, Inc..
- Northeast Mississippi Inpatient Services, LLC
- Northeast Mississippi Planning and Development District
- Northeast Mississippi Planning and Development District
- Northeast Ms Internal Medicine PC
- Ortho Express Holding Company, LLC
- Austin Brock Parris
- Karla Pellizzer
- Performance Physical Therapy, Inc.
- Felesha Dale Perrigo
All providers in Booneville, 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 Aug 28, 2018. 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.