| Magnolia Crossing Mental Health Services Llc | |
|
4780 I 55 N Ste 100 Jackson MS 39211-5583 | |
| (318) 490-8825 | |
| Not Available |
| Full Name | Magnolia Crossing Mental Health Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4780 I 55 N Ste 100, Jackson, Mississippi |
| Authorized Official Name and Position | Tritresher Sizer (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 6019373526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Crossing Mental Health Services Llc 323 Kings Ridge Cir Brandon MS 39047-6031 Ph: () - | Magnolia Crossing Mental Health Services Llc 4780 I 55 N Ste 100 Jackson MS 39211-5583 Ph: (318) 490-8825 |
| NPI Number | 1285324640 |
|---|---|
| Provider Enumeration Date | 05/10/2023 |
| Last Update Date | 11/20/2023 |
| Certification Date | 11/20/2023 |
| Medicare PECOS PAC ID | 8426492364 |
|---|---|
| Medicare Enrollment ID | O20240219001756 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285324640 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Tritresher Sizer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700390184 PECOS PAC ID: 7911245733 Enrollment ID: I20190220001501 |
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