| Behavioral Medicine Clinic,pa | |
|
5000 Hwy 39 N Meridian MS 39301-1021 | |
| (601) 482-2400 | |
| Not Available |
| Full Name | Behavioral Medicine Clinic,pa |
|---|---|
| Speciality | Psychologist |
| Location | 5000 Hwy 39 N, Meridian, Mississippi |
| Authorized Official Name and Position | Terry Jordan (OWNER) |
| Authorized Official Contact | 6014822400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioral Medicine Clinic,pa 5000 Hwy 39 N Meridian MS 39301-1021 Ph: (601) 482-2400 | Behavioral Medicine Clinic,pa 5000 Hwy 39 N Meridian MS 39301-1021 Ph: (601) 482-2400 |
| NPI Number | 1588846281 |
|---|---|
| Provider Enumeration Date | 12/04/2007 |
| Last Update Date | 06/01/2010 |
| Medicare PECOS PAC ID | 5092889360 |
|---|---|
| Medicare Enrollment ID | O20080805000086 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588846281 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | 14095 (Mississippi) | Primary |
| Provider Name | Sharon Ruthanne Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194753962 PECOS PAC ID: 1456306521 Enrollment ID: I20050322000522 |
| Provider Name | Stephen Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548277700 PECOS PAC ID: 2961407242 Enrollment ID: I20060919000568 |
| Provider Name | Rolanda T Pace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386703171 PECOS PAC ID: 8527164326 Enrollment ID: I20070510000160 |
| Provider Name | Terry T Jordan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417046327 PECOS PAC ID: 5597866947 Enrollment ID: I20070730000150 |
| Provider Name | Roshundia L Mckenzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700190592 PECOS PAC ID: 6305030420 Enrollment ID: I20101103000329 |
| Provider Name | Lasaundra Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275847873 PECOS PAC ID: 6406040484 Enrollment ID: I20101103000989 |
| Provider Name | Chandra R Sumlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437278371 PECOS PAC ID: 6800110933 Enrollment ID: I20150121001143 |
| Provider Name | Kelly H Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407346380 PECOS PAC ID: 9133477698 Enrollment ID: I20180731003757 |
| Provider Name | Briana Shanee Brunson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770116030 PECOS PAC ID: 6305216276 Enrollment ID: I20230124002547 |
| Provider Name | Michelle Gomez Dickerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720694029 PECOS PAC ID: 3476997560 Enrollment ID: I20240216001070 |
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