| 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 Ph: () - | 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 | (* (Not Available)) | Primary |
| Provider Name | Ginnifer Poole Hutcheson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740837194 PECOS PAC ID: 6901225101 Enrollment ID: I20201007000611 |
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