| Centerwell Senior Primary Care MS CS PC | |
|
2650 Beach Blvd Ste 40 Biloxi MS 39531-4517 | |
| (407) 447-7120 | |
| Not Available |
| Full Name | Centerwell Senior Primary Care MS CS PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 2650 Beach Blvd Ste 40, Biloxi, Mississippi |
| Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING PROFESSIONAL) |
| Authorized Official Contact | 4074477120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerwell Senior Primary Care MS CS PC 6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (407) 447-7120 | Centerwell Senior Primary Care MS CS PC 2650 Beach Blvd Ste 40 Biloxi MS 39531-4517 Ph: (407) 447-7120 |
| NPI Number | 1730980434 |
|---|---|
| Provider Enumeration Date | 03/20/2025 |
| Last Update Date | 04/23/2025 |
| Certification Date | 04/23/2025 |
| Medicare PECOS PAC ID | 9133638935 |
|---|---|
| Medicare Enrollment ID | O20250603002502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730980434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Secondary |
| 207R00000X | Internal Medicine | (NU) | Primary |
| 208D00000X | General Practice | (NU) | Secondary |
| Provider Name | Jorri Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942505706 PECOS PAC ID: 9234311085 Enrollment ID: I20110315000804 |
| Provider Name | Cyrena Nerissa Muffley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164983060 PECOS PAC ID: 0840528097 Enrollment ID: I20190826002299 |
| Provider Name | Brandon Levi Mizell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649624693 PECOS PAC ID: 9739468562 Enrollment ID: I20190911001720 |
| Provider Name | Kimberly Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770221640 PECOS PAC ID: 5890168579 Enrollment ID: I20230228000515 |
| Provider Name | Ashanti Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720535743 PECOS PAC ID: 7517212848 Enrollment ID: I20250422003416 |
| Provider Name | Kathryn Weber Chrzanowski |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1245326305 PECOS PAC ID: 9830198498 Enrollment ID: I20250707003013 |
| Provider Name | Jonathan Rouwhorst |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508120122 PECOS PAC ID: 9133438633 Enrollment ID: I20251001001532 |
| Provider Name | Courtney Baisden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043808595 PECOS PAC ID: 9830599489 Enrollment ID: I20251021000078 |
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