Latori Diane Wilson Roberts, NURSE PRACTITIONER is a medicare enrolled "Nurse Practitioner - Family" in Hermanville, Mississippi. She graduated from nursing school in 2021 and has 3 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Fast Pace Mississippi Pllc and her current practice location is
6020 Shelby Rd, Hermanville, Mississippi. You can reach out to her office (for appointments etc.) via phone at
(601) 529-3390.
Latori Diane Wilson Roberts is licensed to practice in Mississippi (license number 904922) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1477225902.
Provider's Profile
| Full Name | Latori Diane Wilson Roberts |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 3 Years |
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| Location | 6020 Shelby Rd, Hermanville, Mississippi |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Latori Diane Wilson Roberts graduated from nursing school in 2021
NPI Data:
- NPI Number: 1477225902
- Provider Enumeration Date: 10/04/2021
- Last Update Date: 06/17/2024
Medicare PECOS Information:
- PECOS PAC ID: 9032500947
- Enrollment ID: I20220104002094
Medical Identifiers
Medical identifiers for Latori Diane Wilson Roberts such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1477225902 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 904922 (Mississippi) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Fast Pace Mississippi Pllc | 3678832029 | 142 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Latori Diane Wilson Roberts allows following entities to bill medicare on her behalf.
| Entity Name | Fast Pace Mississippi Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1447769559
PECOS PAC ID: 3678832029
Enrollment ID: O20180111000291 |
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| Entity Name | Signify Health Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1689158487
PECOS PAC ID: 3274895263
Enrollment ID: O20210323002802 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Latori Diane Wilson Roberts is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Latori Diane Wilson Roberts, NURSE PRACTITIONER
6020 Shelby Rd,
Hermanville, MS 39086-9618
Ph: (601) 529-3390 | Latori Diane Wilson Roberts, NURSE PRACTITIONER
6020 Shelby Rd,
Hermanville, MS 39086-9618
Ph: (601) 529-3390 |
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