| Arise Hernando, LLC | |
|
1288 Byhalia Rd Ste 4 Hernando MS 38632-6032 | |
| (662) 432-4106 | |
| Not Available |
| Full Name | Arise Hernando, LLC |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1288 Byhalia Rd Ste 4, Hernando, Mississippi |
| Authorized Official Name and Position | Jay Howell (CHIEF REVENUE OFFICER) |
| Authorized Official Contact | 6622055999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arise Hernando, LLC Po Box 7058 Tupelo MS 38802-7058 | Arise Hernando, LLC 1288 Byhalia Rd Ste 4 Hernando MS 38632-6032 Ph: (662) 432-4106 |
| NPI Number | 1124709993 |
|---|---|
| Provider Enumeration Date | 07/26/2023 |
| Last Update Date | 07/26/2023 |
| Certification Date | 07/25/2023 |
| Medicare PECOS PAC ID | 5799136792 |
|---|---|
| Medicare Enrollment ID | O20240103003690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124709993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | () | Primary |
| Provider Name | Ginnifer Poole Hutcheson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740837194 PECOS PAC ID: 6901225101 Enrollment ID: I20201007000611 |
| Provider Name | Melissa Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598151169 PECOS PAC ID: 5193192656 Enrollment ID: I20221114000811 |
| Provider Name | Lara Hayes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992044754 PECOS PAC ID: 0345786612 Enrollment ID: I20240723001325 |
| Provider Name | Adole Muruako |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073128641 PECOS PAC ID: 4082151865 Enrollment ID: I20240730003113 |
| Provider Name | Davis Abraham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326793654 PECOS PAC ID: 8426595125 Enrollment ID: I20240730004221 |
| Provider Name | Sheria Jo'na Green |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346599461 PECOS PAC ID: 7810428737 Enrollment ID: I20241003000014 |
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