Chaniqua Dominique Smith, PMHNP-BC - Medicare Nurse Practitioner in Southaven, MS

  1. Home
  2. Nurse Practitioner
  3. MS
  4. Southaven
Chaniqua Dominique Smith, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Southaven, Mississippi. Her current practice location is 187 Marathon Way, Southaven, Mississippi. You can reach out to her office (for appointments etc.) via phone at (662) 727-8811.

Chaniqua Dominique Smith is licensed to practice in Tennessee (license number 36433) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1164104543.

Contact Information

Chaniqua Dominique Smith, PMHNP-BC
187 Marathon Way,
Southaven, MS 38671
(662) 727-8811
Not Available

Map and Direction




Provider's Profile

Full NameChaniqua Dominique Smith
GenderFemale
SpecialityNurse Practitioner - Psychiatric/mental Health
Location187 Marathon Way, Southaven, Mississippi
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1164104543
  • Provider Enumeration Date: 08/03/2023
  • Last Update Date: 08/31/2026
  Medicare PECOS Information:
  • PECOS PAC ID: 1557896487
  • Enrollment ID: I20241202000146

Medical Identifiers

Medical identifiers for Chaniqua Dominique Smith such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1164104543NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LP0808XNurse Practitioner - Psychiatric/mental Health 36433 (Tennessee)Primary
363LP0808XNurse Practitioner - Psychiatric/mental Health 906158 (Mississippi)Secondary

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. Chaniqua Dominique Smith allows following entities to bill medicare on her behalf.
Entity NameAthena Consulting and Psychological Services, PLLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1336292465
PECOS PAC ID: 5294719795
Enrollment ID: O20040614001008

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. Chaniqua Dominique Smith 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 AddressPractice Location Address
Chaniqua Dominique Smith, PMHNP-BC
187 Marathon Way,
Southaven, MS 38671

Ph: Not Available		Chaniqua Dominique Smith, PMHNP-BC
187 Marathon Way,
Southaven, MS 38671

Ph: (662) 727-8811

Reviews and Comments


Nurse Practitioner Nurses in Southaven, MS

Mr. Nathaniel Levi Bump, FNP-C
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 7111 Southcrest Pkwy Ste 109, Southaven, MS 38671
Phone: 662-503-7416    Fax: 662-349-9082
Ms. Sherlean D Shugars, NP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 2149 Stateline Rd W, Southaven, MS 38671
Phone: 662-342-1112    
Penny Marie Holley, FNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 3964 Goodman Rd E Ste 128-129, Southaven, MS 38672
Phone: 662-655-0456    Fax: 662-655-0457
Christopher Gully, NP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 363 Southcrest Cir Ste 202, Southaven, MS 38671
Phone: 901-226-0456    Fax: 901-226-0458
Mrs. Christy Le Anne Egbert, FNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 7545 Airways Blvd, Southaven, MS 38671
Phone: 901-759-3100    
Misty Burton, FNP-C
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 391 Southcrest Cir, Southaven, MS 38671
Phone: 662-349-2659    
Mrs. Karen Kamillah Purnell, PMHNP
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 1260 Chestnut Dr, Southaven, MS 38671
Phone: 662-897-8973    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.