| Mid South Systems | |
|
2707 Browns Ln Jonesboro AR 72401-7213 | |
| (870) 972-4000 | |
| (970) 972-4911 |
| Full Name | Mid South Systems |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2707 Browns Ln, Jonesboro, Arkansas |
| Authorized Official Name and Position | Stephen Johnson (ASSISTANT EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8709724000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid South Systems 2707 Browns Ln Jonesboro AR 72401-7213 Ph: (870) 972-4000 | Mid South Systems 2707 Browns Ln Jonesboro AR 72401-7213 Ph: (870) 972-4000 |
| NPI Number | 1336118207 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 04/22/2022 |
| Certification Date | 04/22/2022 |
| Medicare PECOS PAC ID | 0244130839 |
|---|---|
| Medicare Enrollment ID | O20040110000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336118207 | NPI | - | NPPES |
| 128707526 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Dennis R Vowell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730139916 PECOS PAC ID: 2264332857 Enrollment ID: I20040110000192 |
| Provider Name | Sheila R Stinson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1427015940 PECOS PAC ID: 9032010723 Enrollment ID: I20040115001062 |
| Provider Name | Ali Hashmi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720033350 PECOS PAC ID: 0547161929 Enrollment ID: I20040119000204 |
| Provider Name | Kathryn D Bowman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477533024 PECOS PAC ID: 0446242259 Enrollment ID: I20040401000487 |
| Provider Name | Catherine A. Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639182942 PECOS PAC ID: 9931182599 Enrollment ID: I20040612000555 |
| Provider Name | Walter A Darnell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821175423 PECOS PAC ID: 9638154875 Enrollment ID: I20040622000279 |
| Provider Name | Marilyn Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902840531 PECOS PAC ID: 9335124163 Enrollment ID: I20040623001675 |
| Provider Name | Stacy R Arnell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639104920 PECOS PAC ID: 9133108939 Enrollment ID: I20040715000885 |
| Provider Name | Michael D Tomlinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760449342 PECOS PAC ID: 5890756704 Enrollment ID: I20041025000264 |
| Provider Name | Annette S Slater |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295847820 PECOS PAC ID: 0840255840 Enrollment ID: I20041201000177 |
| Provider Name | Mary M Wegner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013983071 PECOS PAC ID: 6800883513 Enrollment ID: I20050110001187 |
| Provider Name | Raymond K Molden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477585982 PECOS PAC ID: 9830135169 Enrollment ID: I20050707001005 |
| Provider Name | James B Moseley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568438505 PECOS PAC ID: 3577594001 Enrollment ID: I20060419000520 |
| Provider Name | Katherine Darling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013960707 PECOS PAC ID: 5496766206 Enrollment ID: I20060508000993 |
| Provider Name | Angie D Hicks-master |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255405353 PECOS PAC ID: 5496858110 Enrollment ID: I20070316000197 |
| Provider Name | Mark A Baltz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194753046 PECOS PAC ID: 4183680507 Enrollment ID: I20070516000547 |
| Provider Name | Brandi Hankins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922129998 PECOS PAC ID: 2668556994 Enrollment ID: I20080226000460 |
| Provider Name | Rebekah L Evans |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1962514562 PECOS PAC ID: 2860571502 Enrollment ID: I20080506000442 |
| Provider Name | Kenneth D Pruett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952524878 PECOS PAC ID: 8224184650 Enrollment ID: I20090925000392 |
| Provider Name | David M Blaske |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790733947 PECOS PAC ID: 3476689118 Enrollment ID: I20100331001300 |
| Provider Name | Muhammad Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417922261 PECOS PAC ID: 6800927450 Enrollment ID: I20100626000340 |
| Provider Name | Janice Bonner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609037423 PECOS PAC ID: 8527183482 Enrollment ID: I20100915000628 |
| Provider Name | Clea M Fairaizl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285814970 PECOS PAC ID: 7911187745 Enrollment ID: I20110210000516 |
| Provider Name | Ruth Ann Carpenter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033235205 PECOS PAC ID: 3476728270 Enrollment ID: I20111206000480 |
| Provider Name | Kelli L Statler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023288826 PECOS PAC ID: 4183887052 Enrollment ID: I20120514000413 |
| Provider Name | Sarita Subba |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134383680 PECOS PAC ID: 0941466734 Enrollment ID: I20120723000960 |
| Provider Name | Vickie L White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134248164 PECOS PAC ID: 4284881962 Enrollment ID: I20120912000108 |
| Provider Name | Paula I Graham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144424573 PECOS PAC ID: 7517116312 Enrollment ID: I20121011000760 |
| Provider Name | Stephen P Pipkin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356659098 PECOS PAC ID: 5092957878 Enrollment ID: I20130807000095 |
| Provider Name | Toni R Dollinger |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1588660054 PECOS PAC ID: 1850482555 Enrollment ID: I20140110000386 |
| Provider Name | Gary W Taber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942416557 PECOS PAC ID: 6901038835 Enrollment ID: I20140408001780 |
| Provider Name | Bobby D Armstrong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346552627 PECOS PAC ID: 1557594322 Enrollment ID: I20140501000229 |
| Provider Name | Pamela G Harness |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053547513 PECOS PAC ID: 6507081197 Enrollment ID: I20140716000919 |
| Provider Name | Natasha L Woods |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295966364 PECOS PAC ID: 8729223441 Enrollment ID: I20141002002542 |
| Provider Name | Ronald A Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053557140 PECOS PAC ID: 3072837939 Enrollment ID: I20150123001657 |
| Provider Name | Kellie Letbetter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336380559 PECOS PAC ID: 1951625581 Enrollment ID: I20150130000580 |
| Provider Name | Ottysha Andria White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255584637 PECOS PAC ID: 9537480892 Enrollment ID: I20150611002374 |
| Provider Name | Rebecca Holman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669519070 PECOS PAC ID: 3173832466 Enrollment ID: I20151028001048 |
| Provider Name | Jennifer R Tubbs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669787990 PECOS PAC ID: 2365744430 Enrollment ID: I20160106001039 |
| Provider Name | Ashlie Williams |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851794523 PECOS PAC ID: 3779880927 Enrollment ID: I20160401001745 |
| Provider Name | Brian Teal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215285028 PECOS PAC ID: 3678871183 Enrollment ID: I20160418001040 |
| Provider Name | Christopher P Debernard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851682116 PECOS PAC ID: 3072734987 Enrollment ID: I20160520000110 |
| Provider Name | Melody Y Mccaig |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184998429 PECOS PAC ID: 3870883887 Enrollment ID: I20160603000871 |
| Provider Name | Sarah E Fray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255887824 PECOS PAC ID: 8426331992 Enrollment ID: I20170207001194 |
| Provider Name | Anthony J Valentine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619270519 PECOS PAC ID: 8729354345 Enrollment ID: I20171026003069 |
| Provider Name | Joseph W Labonte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801314760 PECOS PAC ID: 8527324433 Enrollment ID: I20171109001387 |
| Provider Name | Courtney Myrick Porter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558777896 PECOS PAC ID: 7012275779 Enrollment ID: I20171229001780 |
| Provider Name | Debra Alberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780063438 PECOS PAC ID: 9436466232 Enrollment ID: I20180301002118 |
| Provider Name | Mark Whitney Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770997645 PECOS PAC ID: 7214298272 Enrollment ID: I20180308000205 |
| Provider Name | Heather H Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770953366 PECOS PAC ID: 3274897319 Enrollment ID: I20180426000504 |
| Provider Name | Darice A Barber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780897785 PECOS PAC ID: 8123382132 Enrollment ID: I20180427001133 |
| Provider Name | Amy J Inman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639427099 PECOS PAC ID: 8426319716 Enrollment ID: I20180501000207 |
| Provider Name | Marc C King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982751574 PECOS PAC ID: 8123385606 Enrollment ID: I20180502000606 |
| Provider Name | Richard T Keefer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740693274 PECOS PAC ID: 9032473780 Enrollment ID: I20180503001802 |
| Provider Name | George N Shuler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790710044 PECOS PAC ID: 8729307137 Enrollment ID: I20180509000177 |
| Provider Name | Brittany Rachelle Anders |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033513809 PECOS PAC ID: 5294080289 Enrollment ID: I20180614002374 |
| Provider Name | Robin L Stein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326343856 PECOS PAC ID: 7719233436 Enrollment ID: I20180710002229 |
| Provider Name | Brittany Killian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083082739 PECOS PAC ID: 2769739390 Enrollment ID: I20180727000606 |
| Provider Name | Elise Nichole Griffin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083095541 PECOS PAC ID: 8527310226 Enrollment ID: I20181008002317 |
| Provider Name | Tameka L Smith-granberry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619348703 PECOS PAC ID: 3779827969 Enrollment ID: I20181128002491 |
| Provider Name | Johnathan C Simpson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871737502 PECOS PAC ID: 4486998432 Enrollment ID: I20181203002670 |
| Provider Name | Vicky D Valentine-phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720413842 PECOS PAC ID: 8224390349 Enrollment ID: I20181207002599 |
| Provider Name | Allison M Mcarthur |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780706473 PECOS PAC ID: 5092059576 Enrollment ID: I20181211001026 |
| Provider Name | Jessica L Pipkin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932417631 PECOS PAC ID: 2860739448 Enrollment ID: I20190122001197 |
| Provider Name | Debra Dawn Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073846457 PECOS PAC ID: 5698015907 Enrollment ID: I20190325001048 |
| Provider Name | Jessica M Musgrove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760965008 PECOS PAC ID: 5193068237 Enrollment ID: I20190514000077 |
| Provider Name | Ashley R Larru |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053974030 PECOS PAC ID: 2769716745 Enrollment ID: I20190625002257 |
| Provider Name | Sherry K Armstrong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639198229 PECOS PAC ID: 7719944784 Enrollment ID: I20190824000034 |
| Provider Name | Tisha R Roswell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700235728 PECOS PAC ID: 1355673492 Enrollment ID: I20191023000758 |
| Provider Name | Amy N Freligh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487895900 PECOS PAC ID: 8022340678 Enrollment ID: I20191031000104 |
| Provider Name | James Skinner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669649836 PECOS PAC ID: 9739514357 Enrollment ID: I20200108001839 |
| Provider Name | Marcie L Tuggle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518599091 PECOS PAC ID: 6901233097 Enrollment ID: I20200302002593 |
| Provider Name | Priscilla Alexander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821518242 PECOS PAC ID: 8123456928 Enrollment ID: I20200310000117 |
| Provider Name | Michael A Allensworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356649420 PECOS PAC ID: 5294164331 Enrollment ID: I20200410001364 |
| Provider Name | Cathy I Boyd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407291305 PECOS PAC ID: 5698106151 Enrollment ID: I20200518000230 |
| Provider Name | Tara G Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932339603 PECOS PAC ID: 8628490729 Enrollment ID: I20200618001174 |
| Provider Name | Destiny Mcgee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023490976 PECOS PAC ID: 7214350040 Enrollment ID: I20200713000171 |
| Provider Name | Keisha A Fox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033765490 PECOS PAC ID: 5294159547 Enrollment ID: I20200904001410 |
| Provider Name | Shena Lavespere |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902232671 PECOS PAC ID: 2860811668 Enrollment ID: I20200929000164 |
| Provider Name | Katie Jean Wells |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053833061 PECOS PAC ID: 9537588363 Enrollment ID: I20200929001175 |
| Provider Name | Leslie Tullos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881915668 PECOS PAC ID: 4981023561 Enrollment ID: I20200930003653 |
| Provider Name | Allison Prescott Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790251320 PECOS PAC ID: 6901226745 Enrollment ID: I20201019000034 |
| Provider Name | Brent Gossett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427335975 PECOS PAC ID: 9335550508 Enrollment ID: I20201118002218 |
| Provider Name | Shatoyia Monique Stovall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396247474 PECOS PAC ID: 4688085822 Enrollment ID: I20201119002101 |
| Provider Name | Naricia M Futrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033425483 PECOS PAC ID: 3375861982 Enrollment ID: I20201201000624 |
| Provider Name | Jessica Sandrell Parker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023525060 PECOS PAC ID: 8123432788 Enrollment ID: I20210122001827 |
| Provider Name | Angela Toomey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154735280 PECOS PAC ID: 3678798493 Enrollment ID: I20210209000197 |
| Provider Name | Elizabeth Spurlock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467981456 PECOS PAC ID: 8022427855 Enrollment ID: I20210507001665 |
| Provider Name | Tyler Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225469364 PECOS PAC ID: 1850790163 Enrollment ID: I20210518002653 |
| Provider Name | Anthoney Dickson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275821456 PECOS PAC ID: 4587061452 Enrollment ID: I20210920001206 |
| Provider Name | Megan G Cherry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124611439 PECOS PAC ID: 2567869167 Enrollment ID: I20210924000278 |
| Provider Name | Hannah Booth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447740915 PECOS PAC ID: 7012394539 Enrollment ID: I20220521000129 |
| Provider Name | Sarah Taylor Lipsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609423292 PECOS PAC ID: 1658754510 Enrollment ID: I20220810002793 |
| Provider Name | Kenjarvis Cross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184078875 PECOS PAC ID: 2163805714 Enrollment ID: I20220816000280 |
| Provider Name | Melissa Michelle Hooper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497184535 PECOS PAC ID: 8224412309 Enrollment ID: I20220908003699 |
| Provider Name | Amanda Atchley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164951992 PECOS PAC ID: 5092183202 Enrollment ID: I20221118002665 |
| Provider Name | Chelsea E Thielemier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740837673 PECOS PAC ID: 2860857943 Enrollment ID: I20230424003076 |
| Provider Name | Fatimaah Salaam Carmichael |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548562002 PECOS PAC ID: 8123485679 Enrollment ID: I20230529000135 |
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