| Complete Care Rural Health Clinic | |
|
1911 Mission 66 Ste B Vicksburg MS 39180-3762 | |
| (601) 665-4162 | |
| (855) 830-3484 |
| Full Name | Complete Care Rural Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1911 Mission 66 Ste B, Vicksburg, Mississippi |
| Authorized Official Name and Position | Christopher J Watkins (MEMBER) |
| Authorized Official Contact | 6019519863 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Complete Care Rural Health Clinic 215 Katherine Drive Suite A Flowood MS 39232-9588 Ph: (601) 665-4162 | Complete Care Rural Health Clinic 1911 Mission 66 Ste B Vicksburg MS 39180-3762 Ph: (601) 665-4162 |
| NPI Number | 1669835310 |
|---|---|
| Provider Enumeration Date | 03/31/2016 |
| Last Update Date | 09/06/2023 |
| Certification Date | 09/06/2023 |
| Medicare PECOS PAC ID | 0749572915 |
|---|---|
| Medicare Enrollment ID | O20160708000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669835310 | NPI | - | NPPES |
| 007877558 | Medicaid | MS | |
| 001583061 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Mississippi) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Gary A Roberson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629133400 PECOS PAC ID: 1456252618 Enrollment ID: I20040120000367 |
| Provider Name | Gloria J Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245213354 PECOS PAC ID: 1759312481 Enrollment ID: I20050823000484 |
| Provider Name | Laurie S Steward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609809243 PECOS PAC ID: 1153331582 Enrollment ID: I20090826000913 |
| Provider Name | Alice T Cohea |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942309638 PECOS PAC ID: 7214079334 Enrollment ID: I20100127000476 |
| Provider Name | Timothy Duncan Estes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285746511 PECOS PAC ID: 5698664019 Enrollment ID: I20110322000064 |
| Provider Name | Bonny A Saucier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306126271 PECOS PAC ID: 2668644824 Enrollment ID: I20111012000108 |
| Provider Name | Stella S Culliver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821365511 PECOS PAC ID: 1658547815 Enrollment ID: I20120110000574 |
| Provider Name | Laura King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801179791 PECOS PAC ID: 8325215924 Enrollment ID: I20120123000635 |
| Provider Name | Toni L. Ladner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922374057 PECOS PAC ID: 6507027588 Enrollment ID: I20120418000785 |
| Provider Name | Amanda Carson-griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124456850 PECOS PAC ID: 8022247527 Enrollment ID: I20140203001154 |
| Provider Name | Shawnta Gandy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366851321 PECOS PAC ID: 3577889252 Enrollment ID: I20150225000653 |
| Provider Name | Mazhar Salim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013075449 PECOS PAC ID: 4789775842 Enrollment ID: I20160413001187 |
| Provider Name | Anuj Marya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093155376 PECOS PAC ID: 3870817661 Enrollment ID: I20161108000910 |
| Provider Name | Yolanda Yvette Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841719903 PECOS PAC ID: 6608132071 Enrollment ID: I20171117002733 |
| Provider Name | Meagan M Dear |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346765526 PECOS PAC ID: 5092077529 Enrollment ID: I20180322000266 |
| Provider Name | Sonya Whatley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841756731 PECOS PAC ID: 7214270131 Enrollment ID: I20190516001935 |
| Provider Name | Jacquelyne D Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578020459 PECOS PAC ID: 1850625088 Enrollment ID: I20190621002298 |
| Provider Name | Latasha Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306480439 PECOS PAC ID: 9234564634 Enrollment ID: I20200114000221 |
| Provider Name | Lucy M Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659971380 PECOS PAC ID: 9638588692 Enrollment ID: I20210505000068 |
| Provider Name | Mia R Tait |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376193094 PECOS PAC ID: 9335537950 Enrollment ID: I20211101000009 |
| Provider Name | Erica Thurman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699423939 PECOS PAC ID: 4688061534 Enrollment ID: I20220425001604 |
| Provider Name | Stephanie Kay Roe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629667340 PECOS PAC ID: 5698130664 Enrollment ID: I20230426000865 |
| Provider Name | Rebecca Ann Rayborn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710674155 PECOS PAC ID: 6204292444 Enrollment ID: I20230515001107 |
| Provider Name | Teres Chandler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477017754 PECOS PAC ID: 3870916612 Enrollment ID: I20231009002731 |
| Provider Name | Charmie M Murphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912682048 PECOS PAC ID: 6709233117 Enrollment ID: I20231107001502 |
| Provider Name | Ellen Peters Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639745904 PECOS PAC ID: 9830538925 Enrollment ID: I20240423001147 |
| Provider Name | Carey A Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396487112 PECOS PAC ID: 9234579004 Enrollment ID: I20240426000352 |
| Provider Name | Lavera G Mccaskill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316272834 PECOS PAC ID: 2567802341 Enrollment ID: I20240426000990 |
| Provider Name | June M Linley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609072156 PECOS PAC ID: 4789024571 Enrollment ID: I20240426001277 |
| Provider Name | Lakesha L Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578264776 PECOS PAC ID: 0345680153 Enrollment ID: I20240426002069 |
| Provider Name | Lapatrick D Stephens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184380156 PECOS PAC ID: 6901246511 Enrollment ID: I20240430002419 |
| Provider Name | Jennifer L Borum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538622089 PECOS PAC ID: 9638519093 Enrollment ID: I20240502000125 |
| Provider Name | Kayla L Moriarty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033830641 PECOS PAC ID: 7113367327 Enrollment ID: I20240503002331 |
| Provider Name | Tokikie R Williamson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871186833 PECOS PAC ID: 1951742931 Enrollment ID: I20240508000729 |
| Provider Name | Ambriel S Kinney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053099564 PECOS PAC ID: 0749621613 Enrollment ID: I20240509000385 |
| Provider Name | Mary Kathleen Thoman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013469097 PECOS PAC ID: 4385085273 Enrollment ID: I20240509001228 |
| Provider Name | Miriam G Bond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366864134 PECOS PAC ID: 1153762612 Enrollment ID: I20240515000754 |
| Provider Name | Natalie W Lassiter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942708532 PECOS PAC ID: 0648611129 Enrollment ID: I20240515001351 |
| Provider Name | Anna Adcock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033866835 PECOS PAC ID: 4385085802 Enrollment ID: I20240515003061 |
| Provider Name | Jennifer T Porter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144957408 PECOS PAC ID: 1658712971 Enrollment ID: I20240516003197 |
| Provider Name | Tina Crane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548907272 PECOS PAC ID: 9638510837 Enrollment ID: I20240517002267 |
| Provider Name | Christy Busby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598385130 PECOS PAC ID: 7618318825 Enrollment ID: I20240517002491 |
| Provider Name | Morchell S Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659823177 PECOS PAC ID: 7517308737 Enrollment ID: I20240517002929 |
| Provider Name | Rose M Favre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699556068 PECOS PAC ID: 1557703741 Enrollment ID: I20240520001597 |
| Provider Name | Kayla N Felker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912422213 PECOS PAC ID: 0042652281 Enrollment ID: I20240520003683 |
| Provider Name | Ashlie L Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720437817 PECOS PAC ID: 9234571209 Enrollment ID: I20240522000564 |
| Provider Name | Justin R Ragon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093325409 PECOS PAC ID: 4880094945 Enrollment ID: I20240528002568 |
Warren Yazoo Mental Health Service Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 3444 Wisconsin Ave, Vicksburg, MS 39180 Phone: 601-638-0031 Fax: 601-634-0234 | |
The Peace Place Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1301 Holly St, Vicksburg, MS 39180 Phone: 601-630-3362 Fax: 855-540-0718 | |
Divine Home Care Changes Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 106 Ethel Dr, Vicksburg, MS 39180 Phone: 919-339-1854 | |
Nulife Healthcare, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 120 Holt Collier Dr Ste C, Vicksburg, MS 39183 Phone: 601-738-5565 Fax: 601-738-5544 | |
Cognitive Development Center Of Mississippi Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1713 Clay St, Vicksburg, MS 39183 Phone: 601-883-1771 Fax: 601-883-1773 | |
Gateway Health Services Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2705 Clay St, Vicksburg, MS 39183 Phone: 601-661-9752 Fax: 601-661-6021 | |
Nulife Health Care Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 120 Holt Collier Dr Ste C, Vicksburg, MS 39183 Phone: 601-738-5565 Fax: 601-738-5544 |