| Warren Yazoo Mental Health Service | |
|
3444 Wisconsin Ave Vicksburg MS 39180-5331 | |
| (601) 638-0031 | |
| (601) 634-0234 |
| Full Name | Warren Yazoo Mental Health Service |
|---|---|
| Speciality | Clinic/Center |
| Location | 3444 Wisconsin Ave, Vicksburg, Mississippi |
| Authorized Official Name and Position | Rick Vessell (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6016380031 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Warren Yazoo Mental Health Service 3444 Wisconsin Ave Vicksburg MS 39180-5331 Ph: (601) 638-0031 | Warren Yazoo Mental Health Service 3444 Wisconsin Ave Vicksburg MS 39180-5331 Ph: (601) 638-0031 |
| NPI Number | 1023002920 |
|---|---|
| Provider Enumeration Date | 09/07/2005 |
| Last Update Date | 02/06/2017 |
| Medicare PECOS PAC ID | 2365418167 |
|---|---|
| Medicare Enrollment ID | O20040902001140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023002920 | NPI | - | NPPES |
| 00018215 | Medicaid | MS | |
| 00770336 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | R15-1 (Mississippi) | Primary |
| Provider Name | Joseph A Kwentus |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1477582096 PECOS PAC ID: 3678567245 Enrollment ID: I20040414001441 |
| Provider Name | Parveen Kumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366544603 PECOS PAC ID: 6002896032 Enrollment ID: I20040721001010 |
| Provider Name | Maxie Lerone Gordon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427018613 PECOS PAC ID: 2466406798 Enrollment ID: I20050309000456 |
| Provider Name | Raymundo C Trinanes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487727095 PECOS PAC ID: 9335246727 Enrollment ID: I20070518000530 |
| Provider Name | Ashley T Karel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881989911 PECOS PAC ID: 0941476469 Enrollment ID: I20120105000366 |
| Provider Name | Joyce C Vaughn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053681213 PECOS PAC ID: 8527228162 Enrollment ID: I20120320000164 |
| Provider Name | Billy R Walton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871980995 PECOS PAC ID: 1759693377 Enrollment ID: I20150709002251 |
| Provider Name | Hailey Parks Beckwith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326521048 PECOS PAC ID: 1951645589 Enrollment ID: I20181207001035 |
| Provider Name | Christa L Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215416250 PECOS PAC ID: 5991040321 Enrollment ID: I20181213000180 |
| Provider Name | Lakeeia Lashoundra Myles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326687344 PECOS PAC ID: 5799110722 Enrollment ID: I20200121000237 |
| Provider Name | Saketa C Mcentee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205540804 PECOS PAC ID: 0446624449 Enrollment ID: I20230314001895 |
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