Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 1041C0700X | Social Worker | Clinical | | | No |
| 2 | 163WP0807X | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | | | No |
| 3 | 225X00000X | Occupational Therapist | | | | No |
| 4 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 5 | 261QR0401X | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | | | No |
| 6 | 291U00000X | Clinical Medical Laboratory | | | | No |
| 7 | 363L00000X | Nurse Practitioner | | | | No |
| 8 | 363LC1500X | Nurse Practitioner | Community Health | | | No |
| 9 | 363LF0000X | Nurse Practitioner | Family | | | No |
| 10 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 11 | 363LW0102X | Nurse Practitioner | Women's Health | | | No |
| 12 | 364S00000X | Clinical Nurse Specialist | | | | No |
| 13 | 364SP0807X | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | | | Yes |
| 14 | 364SP0808X | Clinical Nurse Specialist | Psychiatric/Mental Health | | | No |
| 15 | 225XM0800X | Occupational Therapist | Mental Health | | | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 03320311 | MEDICAID | MISSISSIPPI | |
| 2 | 1C5803 | OTHER | TEXAS | GROUP |
| 3 | 25D2200016 | OTHER | MISSISSIPPI | CLIA |
