| Hernando Psychiatry Llc | |
|
324 W Valley St Ste 108 Hernando MS 38632-1749 | |
| (901) 491-0130 | |
| Not Available |
| Full Name | Hernando Psychiatry Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 324 W Valley St Ste 108, Hernando, Mississippi |
| Authorized Official Name and Position | Ethan Tyler Smitherman (OWNER) |
| Authorized Official Contact | 9014910130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hernando Psychiatry Llc 324 W Valley St Ste 108 Hernando MS 38632-1749 Ph: (901) 491-0130 | Hernando Psychiatry Llc 324 W Valley St Ste 108 Hernando MS 38632-1749 Ph: (901) 491-0130 |
| NPI Number | 1912600750 |
|---|---|
| Provider Enumeration Date | 03/22/2023 |
| Last Update Date | 03/22/2023 |
| Certification Date | 03/22/2023 |
| Medicare PECOS PAC ID | 5698138998 |
|---|---|
| Medicare Enrollment ID | O20230905002044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912600750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Ethan Tyler Smitherman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316643398 PECOS PAC ID: 6507229804 Enrollment ID: I20230905002328 |
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