Dr Nina Nicole Jefferson, PSYD is a medicare enrolled "Psychologist - Clinical" provider in Monticello, Arkansas. Her current practice location is
766 Hl Ross Dr, Monticello, Arkansas. You can reach out to her office (for appointments etc.) via phone at
(870) 367-6246.
Dr Nina Nicole Jefferson is licensed to practice in Arkansas (license number 15-06P) 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 1881912137.
Healthcare Provider's Profile
| Full Name | Dr Nina Nicole Jefferson |
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| Gender | Female |
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| Speciality | Psychologist - Clinical |
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| Location | 766 Hl Ross Dr, Monticello, Arkansas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1881912137
- Provider Enumeration Date: 05/12/2010
- Last Update Date: 07/21/2022
Medicare PECOS Information:
- PECOS PAC ID: 3971795410
- Enrollment ID: I20101005001185
Medical Identifiers
Medical identifiers for Dr Nina Nicole Jefferson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1881912137 | NPI | - | NPPES |
| 003100346A | Medicaid | GA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TC0700X | Psychologist - Clinical | PSY003323 (Georgia) | Secondary |
| 103TC0700X | Psychologist - Clinical | 15-06P (Arkansas) | Primary |
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. Dr Nina Nicole Jefferson allows following entities to bill medicare on her behalf.
| Entity Name | Wellspring Ge Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1417731563
PECOS PAC ID: 7911356126
Enrollment ID: O20231213003300 |
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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. Dr Nina Nicole Jefferson 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 Address | Practice Location Address |
|---|
Dr Nina Nicole Jefferson, PSYD
Po Box 509,
Dermott, AR 71638
Ph: (870) 538-5414 | Dr Nina Nicole Jefferson, PSYD
766 Hl Ross Dr,
Monticello, AR 71655
Ph: (870) 367-6246 |
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