Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03481574
1760492037
ABAI, AJA A MD
HATTIESBURG
MS
00931072
1790081156
ABAVARE, CHARLES K DO
TUPELO
MS
07708271
1982991246
ABBAS, NOAH H MD
GREENVILLE
MS
00115622
1669485983
ABBOUD, ELIAS H MD
LEXINGTON
MS
09922811
1831159037
ABDEL-AZIZ, AHMED S MD
GREENWOOD
MS
04928312
1821392275
ABDELKARIM, AHMAD A
JACKSON
MS
05431501
1811935323
ABDUL-RAHMAN, OMAR A
JACKSON
MS
00938281
1386804110
ABDULLAH, ABDULLAH N MD
OLIVE BRANCH
MS
09857534
1053332296
ABED, HUSAM MD
JACKSON
MS
04677873
1134356272
ABEL, KEVIN MD
BALDWYN
MS
00002751
1891194635
ABI SALEH, ROLA MD
JACKSON
MS
00123311
1881643500
ABLES, DEBORAH
SEBASTOPOL
MS
00114239
1184669798
ABRAHAM, GEORGE MD
VICKSBURG
MS
04021333
1518052257
ABRAHAM, GEORGE E MD
JACKSON
MS
00012609
1013931674
ABRAHAM, RALPH E MD
HATTIESBURG
MS
08577555
1316319353
ABRAHAM, WHITNEY W FNP-C
COLUMBUS
MS
05736588
1376620849
ABRAMS, MARY E NP
COLUMBUS
MS
03471208
1255658589
ABSTON, TIMOTHY A MD
JACKSON
MS
00123298
1356482459
ABU-HAMDAN, KHALED N MD
GREENVILLE
MS
08570336
1932109378
ABUBAKR, ABUHUZIEFA MD
JACKSON
MS
00117215
1124062492
ABUSAA, TAYSIR M MD
JACKSON
MS
05074887
1255793642
ABUZEID, FOUAD A MD
JACKSON
MS
03321553
1053750018
ACHARAYA, PRAKRATI C MD
JACKSON
MS
00114685
1831201862
ACHARYA, AJAY A MD
MOUND BAYOU
MS
00388745
1437512506
ACHARYA, CHIRAG M MD
JACKSON
MS
01723270
1538213814
ACHORN, FRANK P
MERIDIAN
MS
07529360
1841356169
ACOSTA, JOHN A DDS
SOUTHAVEN
MS
00113758
1720060551
ACOSTA, JOSEPH R
MERIDIAN
MS
1
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04172869
1629194212
ACOTT, ALISON A MD
JACKSON
MS
00119697
1013922814
ACQUAH, EKOW J MD
GULFPORT
MS
00118140
1811074511
ADAMS JR, AUDIE M MD
SENATOBIA
MS
02528740
1528263936
ADAMS JR, JOHN D MD
JACKSON
MS
06278532
1396993663
ADAMS, AMY D DO
LAUREL
MS
07175579
1013204742
ADAMS, ANDREW B MD
DIAMONDHEAD
MS
01628047
1073533261
ADAMS, BARBARA J
GREENVILLE
MS
08709246
1154796365
ADAMS, BRIAN D FNP
COLUMBUS
MS
02684069
1437540184
ADAMS, CASEY NP
GULFPORT
MS
09537703
1114969011
ADAMS, CRAIG V MD
JACKSON
MS
05336815
1235170267
ADAMS, DARRYL L CFNP
D'IBERVILLE
MS
00116484
1033137658
ADAMS, DENNIS U MD
MENDENHALL
MS
05553875
1528410727
ADAMS, DOROTHY D PMHNP
JACKSON
MS
00016917
1194811471
ADAMS, HANS W MD
GULFPORT
MS
01006508
1396964631
ADAMS, JAMES G MD
GREENWOOD
MS
00116244
1255371589
ADAMS, JANICE M CFNP
GREENVILLE
MS
00854539
1023458452
ADAMS, JEREMY C MD
JACKSON
MS
06734277
1174813018
ADAMS, JERIELLE L MD
JACKSON
MS
00120868
1639109739
ADAMS, JOHN B MD
FLOWOOD
MS
05075871
1912003005
ADAMS, JOSEPH C MD
TUPELO
MS
04970772
1811313281
ADAMS, KRISTEN V MD
JACKSON
MS
07277216
1942423470
ADAMS, ROLAND A DDS
JACKSON
MS
01459341
1659733632
ADAMS, SARAH A DO
JACKSON
MS
04970604
1508309501
ADAMS, TAYLOR L FNP
MERIDIAN
MS
00127033
1427082726
ADAMS, TIMOTHY DPM
CHOCTAW
MS
02653240
1750386066
ADCOCK, DAVID W MD
JACKSON
MS
06425360
1851841548
ADCOCK, DOROTHY L FNP
JACKSON
MS
09289797
1407018302
ADCOCK, MICHAEL A MD
FLOWOOD
MS
2
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00116199
1396816989
ADDISON, HOLLAND M MD
JACKSON
MS
02635095
1720088016
ADEDIPE, OLUBENGA MD
BATESVILLE
MS
00253023
1649213455
ADELEYE, JAIYEOLA O MD
CLARKSDALE
MS
08254310
1225379050
ADELEYE, OLAMIDE O NP
SOUTHAVEN
MS
06180721
1073567251
ADELEYE, OLUFEMI O
SOUTHAVEN
MS
00123002
1700805363
ADEN, LESLIE B MD
FLOWOOD
MS
00117429
1174558712
ADEN, WILLIAM M MD
FLOWOOD
MS
00581268
1134151624
ADESANOYE, ADETUNJI E MD
CANTON
MS
00121344
1861414708
ADESOJI, GAFAR A
SOUTHAVEN
MS
00121343
1043232986
ADESOJI, REMILEKUN S
SOUTHAVEN
MS
01651039
1992116719
ADEYANJUFUNKE OLAIGBE, OLAOLUWA MD
JACKSON
MS
05504727
1225480031
ADIBA, AFIFA MD
JACKSON
MS
06534236
1689961278
ADIKE, VIVEKANANDA MD
GREENWOOD
MS
01027725
1285655605
ADKINS, DEAN R PA
HATTIESBURG
MS
06902563
1568563385
ADKINS, JONATHAN R MD
JACKSON
MS
00113910
1629056502
ADKINS, TODD N MD
JACKSON
MS
00060334
1124239504
ADKINS, WILLIAM M DMD
MACON
MS
05555520
1356550594
ADLAKHA, SATJIT DO
OCEAN SPRINGS
MS
00116772
1669561692
ADMAS, JOHN L MD
JACKSON
MS
08404051
1487890497
AFRIDI, SHABINA N MD
HATTIESBURG
MS
08958249
1770873093
AFSHAN, SABAHAT MD
JACKSON
MS
02437244
1730377607
AGANS, STEPHEN C MD
GULFPORT
MS
05955368
1407061781
AGARWAL, MOHIT MD
JACKSON
MS
09932875
1659687788
AGARWAL, RAJENDER K MD
TUPELO
MS
06039299
1386938058
AGBANYIM, GABRIEL MD
PICAYUNE
MS
00150271
1871805820
AGENT, KIMBERLY C FNP-C
CARTHAGE
MS
02432061
1316154974
AGGARWAL, AVICHAL MD
JACKSON
MS
04475870
1790197416
AGNEW, SHAWANDA N MD
CLARKSDALE
MS
3
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09206796
1346311404
AGNONE, JOHN H MD
VICKSBURG
MS
05029265
1184853913
AGRAWAL, KHUSHBOO MD
TUPELO
MS
09538224
1285897553
AGUILAR DUENAS, SANTIAGO MD
SOUTHAVEN
MS
04608247
1962856419
AHLUWALIA, SAHIBA B MD
JACKSON
MS
00118561
1275516387
AHMAD, RAFIQUE MD
MERIDIAN
MS
00115474
1235111592
AHMAD, RAZEE A
MERIDIAN
MS
04478840
1316118300
AHMAD, SHEMA R MD
JACKSON
MS
00124344
1255435889
AHMED, ISRAR MD
HAZLEHURST
MS
00119831
1861458762
AHMED, MOHAMMAD A
HATTIESBURG
MS
05589211
1942224514
AHMED, MOHAMMED R M.D.
HATTIESBURG
MS
09432818
1134339286
AHUJA, MOHIT MD
FLOWOOD
MS
06120550
1578904199
AHUJA, SHRADHA MD
JACKSON
MS
06536208
1992826721
AIKEN, JAMES B MD
POPLARVILLE
MS
07036868
1467804476
AINSWORTH, JACQUELYN R FNP
MARKS
MS
05056260
1912386863
AINSWORTH, LUCAS C MD
JACKSON
MS
01783376
1982632063
AJAGBE, OLUKUNLE A MD
MCCOMB
MS
05804764
1740629351
AJAYI, OPEYEMI M MD
ACKERMAN
MS
04239816
1578530796
AKATUE, RICHMOND A MD
SENATOBIA
MS
00116916
1851411425
AKERS, PAULA S NP
OXFORD
MS
07378562
1356361786
AKHTAR, ISRAH MD
JACKSON
MS
00660129
1063422616
AKIN, RICHARD K DDS
BAY SAINT LOUIS
MS
00660340
1487750832
AKIN, RICHARD R DMD
HAZLEHURST
MS
01875525
1083871818
AKINWALE, ABUMERE F MD
HATTIESBURG
MS
06403709
1215022694
AKINWALE, AKINREMI A M.D.
NATCHEZ
MS
05070388
1821243171
AKULA, YOUGANDHAR V MD
JACKSON
MS
02902345
1447379300
AL GODI, ZHEAR MD
AMORY
MS
03452713
1104121227
AL-BAYATI, ALHAMZA R MD
JACKSON
MS
06125553
1942640362
AL-RAMADHANI, RUBA MD
JACKSON
MS
4
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00012171
1295840510
ALABASTER, ALAN M MD
SOUTHAVEN
MS
05375374
1821453648
ALABI, OLAMIDE S NP
TUPELO
MS
00118541
1891767687
ALBERS, TIMOTHY A
TUPELO
MS
04158895
1346668514
ALBERT, ASHLEY A MD
JACKSON
MS
03637752
1235494741
ALBERT, BENJAMIN M MD
JACKSON
MS
00018403
1679562094
ALBERT, MICHAEL H MD
PEARL
MS
01601267
1295964039
ALBERTS, SCOTT J CNP
HATTIESBURG
MS
05189360
1942678875
ALBONETTI, NICHOLAS FNP
SOUTHAVEN
MS
05259761
1962539577
ALBRECHT, SVENJA J MD
JACKSON
MS
00019708
1053373316
ALBRIGHT, ANTHONY MD
PICAYUNE
MS
06275325
1164448981
ALDER, VALARIE M CRNP
CORINTH
MS
00601500
1437413770
ALDERMAN III, JOSHUA C CNP
WIGGINS
MS
06487860
1659330231
ALDINGER, SEAN OD
OLIVE BRANCH
MS
09074754
1124439146
ALDRED, JUSTIN A DO
JACKSON
MS
02504301
1720428121
ALDRED, LEWIS W MD
JACKSON
MS
00123127
1427148667
ALDRIDGE, EDWARD F M.D.
OCEAN SPRINGS
MS
00125563
1508815713
ALDRIDGE, MARCENIA
MCCOMB
MS
00122406
1063525624
ALEEM, SARKER A
OXFORD
MS
00429843
1396083630
ALEJANDRO TAVAREZ ROBIOU, JOSE MD
AMORY
MS
00123692
1336145770
ALEXANDER III, RICHMOND L MD
MERIDIAN
MS
00060035
1598776924
ALEXANDER JR, KELLY D
HOLLANDALE
MS
09136733
1104198266
ALEXANDER, AMIE L NP-C
BILOXI
MS
00119465
1083661946
ALEXANDER, BELINDA B MD
BILOXI
MS
00126950
1790828580
ALEXANDER, BETTY JO CPNP
PICAYUNE
MS
04828561
1962716894
ALEXANDER, KATHRYN C FNP-C
JACKSON
MS
07356036
1104277136
ALEXANDER, KELLY P NP
JACKSON
MS
00377010
1912249343
ALEXANDER, KELVINNA FNP
TUNICA
MS
04626507
1780881128
ALEXANDER, LAURA E D.O.
MERIDIAN
MS
5
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118703
1073595989
ALEXANDER, LON F MD
HATTIESBURG
MS
00115251
1285648063
ALEXANDER, MYRNA E MD
JACKSON
MS
00188545
1972739837
ALEXANDER, SURESH M MD
JACKSON
MS
03028562
1699956318
ALEXANDER, TERESA G APRN
MERIDIAN
MS
00118702
1861416042
ALEXIS, KATHERINE P
HATTIESBURG
MS
00116392
1639261597
ALFORD, DONNA L CNP
CHOCTAW
MS
00115762
1023070067
ALFORD, TIMOTHY J MD
KOSCIUSKO
MS
05324298
1770848434
ALGEE, LINDSEY E NP
NEW ALBANY
MS
06738091
1063893071
ALHARIR, MICHAEL I DDS
SOUTHAVEN
MS
03703071
1659755627
ALI, AFRAH A MD
JACKSON
MS
09352035
1326248824
ALI, ISHAQ
MORTON
MS
00114335
1164468468
ALI, JEFFREY A MD
JACKSON
MS
06225261
1679759898
ALI, MOHAMMAD A MD
JACKSON
MS
07684894
1023427481
ALI, NASEEM
SOUTHAVEN
MS
00114254
1649297201
ALI, RASHAD N MD
LAUREL
MS
00121559
1497735039
ALI, RONNIE DO
GULFPORT
MS
01289552
1801989124
ALI, SALEEM A MD
COLUMBUS
MS
99999998
ALL NINES, PROVIDER
RIDGELAND
MS
01999999
ALL NINES, PROVIDER
RIDGELAND
MS
05188833
1700016763
ALLA, SRIDEVI MD
JACKSON
MS
09676261
1477667327
ALLBRIGHT, ROBERT M MD
JACKSON
MS
00015062
1295702595
ALLEN JR., RAY M MD
SOUTHAVEN
MS
09686835
1770923815
ALLEN, BRIDGER A DMD
GULFPORT
MS
00120124
1679668487
ALLEN, CYNTHIA E MD
FLOWOOD
MS
02287238
1871964502
ALLEN, DIXIE L
SOUTHAVEN
MS
09870004
1154531234
ALLEN, DUSTIN S MD
PASCAGOULA
MS
08287001
1184946170
ALLEN, ELIZABETH CFNP
JACKSON
MS
04720264
1013390608
ALLEN, EMILY B DO
JACKSON
MS
6
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00014132
1003898412
ALLEN, II, SAMUEL M MD
QUITMAN
MS
08822205
1518201714
ALLEN, JEFFREY M DMD
HATTIESBURG
MS
05001549
1417275652
ALLEN, JOHN C MD
HATTIESBURG
MS
00124398
1801868666
ALLEN, JOHN W
TUPELO
MS
00119924
1780790535
ALLEN, KRIS M CPNP
LONG BEACH
MS
00320511
1174803829
ALLEN, MARIE FNP
JACKSON
MS
06733243
1710217914
ALLEN, PENNIE L
HATTIESBURG
MS
01283342
1750398038
ALLEN, ROBIN M NP
GULFPORT
MS
09689701
1730491036
ALLEN, SUMMER L MD
JACKSON
MS
06600273
1295009330
ALLEN, TARA J MSN
JACKSON
MS
03189253
1346318011
ALLEN, WILLIAM MD
GREENWOOD
MS
01923049
1568711638
ALLEN, ZELMA NP
HORN LAKE
MS
09337556
1457582629
ALLEYNE, PAUL MD
JACKSON
MS
00150706
1124374673
ALLGOOD, MARGARET T FNP
COLUMBUS
MS
02600861
1790104297
ALLISON, CHRISTIAN A NP-C
GUNTOWN
MS
08178056
1467621524
ALLISON, SEAN C MD
OCEAN SPRINGS
MS
05753574
1538377981
ALLISON, SHELTON MD
HATTIESBURG
MS
04387711
1528248960
ALLMAN, RUSSELL E MD
GULFPORT
MS
05821751
1679018410
ALLRED, CASSIE B PA-C
NEW ALBANY
MS
00118107
1548217904
ALMAND, JEFF D MD
JACKSON
MS
07087229
1396992244
ALMON, WENDY R DMD
CANTON
MS
00984324
1215960786
ALNAS, WAIL MD
COLUMBUS
MS
07539809
1386926434
ALRIDGE, GLORIA NP
LAUREL
MS
00126535
1023073251
ALSHEIKH, NABIH
HATTIESBURG
MS
09259057
1952494718
ALTMYER, CHAD S MD
COLUMBUS
MS
08830864
1487680773
ALUR, PRADEEP MD
JACKSON
MS
08278865
1548259559
ALUR, RADHA MD
BRANDON
MS
05620288
1962898015
ALVAREZ, KRISTIE A MD
JACKSON
MS
7
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09520723
1780762534
AMANKONAH, THOMAS D MD
JACKSON
MS
00120742
1063471761
AMANN, STEPHEN T MD
TUPELO
MS
04222533
1073928941
AMOLENDA, PATRICIA G MD
JACKSON
MS
05303767
1134447030
AMOLI, MARIELLE A MD
SOUTHAVEN
MS
01553380
1003059874
AMOS, AARON A MD
TUPELO
MS
00125127
1659362457
AMPONSAH, AKWASI A MD
HATTIESBURG
MS
00804004
1437102597
AMUNDSON, ERIC W MD
JACKSON
MS
00624711
1003836818
ANAND, SUWARNA MD
JACKSON
MS
05635067
1861832446
ANAND, TWINKLE DDS
OXFORD
MS
00012430
1689763856
ANAND, VINOD K MD
JACKSON
MS
01608273
1740547199
ANANTHA, NAVEEN K MD
AMORY
MS
03622075
1053660969
ANARA, CYRIL U MD
JACKSON
MS
07606739
1760563548
ANASTASIO, ROGER M MD
HATTIESBURG
MS
00188566
1497045512
ANAZIA, GREGG O MD
HATTIESBURG
MS
05903032
1851681969
ANAZIA, TASHEITHA V MD
HATTIESBURG
MS
00121885
1245232792
ANAZIA, VICTOR O DO
MCCOMB
MS
05029898
1174943617
ANDERS, EDWIN A MD
JACKSON
MS
00855049
1861854952
ANDERS, MICHAEL A MD
JACKSON
MS
09825097
1467617290
ANDERS-MILLIKEN, BRIDGET A OD
NATCHEZ
MS
06655829
1932321742
ANDERSON III, OTIS MD
SOUTHAVEN
MS
09356273
1396814109
ANDERSON JR, ANDREW J
JACKSON
MS
05984200
1982792198
ANDERSON JR, PERCY L DPM
JACKSON
MS
01823766
1184040172
ANDERSON, ASHLEY D OD
BILOXI
MS
06752300
1801951496
ANDERSON, CHRISTOPHER D MD
JACKSON
MS
04501097
1598947590
ANDERSON, DEBORAH R CNP
GULFPORT
MS
03482206
1235676792
ANDERSON, DOUGLAS P PA
NEW ALBANY
MS
03335340
1447645411
ANDERSON, GEORGE M MD
JACKSON
MS
08487007
1851326813
ANDERSON, JEFFREY R DO
NATCHEZ
MS
8
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00660293
1821011123
ANDERSON, JR, LEON DMD
JACKSON
MS
01959373
1447632351
ANDERSON, KRISTIE L CFNP
LEXINGTON
MS
01276367
1730590258
ANDERSON, LEAH C MD
WAYNESBORO
MS
00122742
1699703389
ANDERSON, LISA MD
JACKSON
MS
07276855
1922202415
ANDERSON, MARK D MD
JACKSON
MS
04374866
1477090728
ANDERSON, META H FNP
MOUND BAYOU
MS
02205931
1134280407
ANDERSON, ROBERT K MD
JACKSON
MS
00121517
1013043009
ANDERSON, RUSSELL S MD
MERIDIAN
MS
00120272
1003831397
ANDERSON, SHAWN C DO
MERIDIAN
MS
02607511
1508206913
ANDERSON, STEPHEN D MD
JACKSON
MS
00122761
1487708525
ANDERSON, TANYA R SAVAGE MD
PORT GIBSON
MS
08903768
1700865235
ANDREACCHIO, STACY R FNP
MERIDIAN
MS
03029265
1285829200
ANDREI, ANAMARIA MD
JACKSON
MS
08275215
1902998537
ANDREWS, DARLENIA T RN
JACKSON
MS
00060419
1114041464
ANDREWS, JEFFREY L DMD
DREW
MS
08482751
1447690599
ANDREWS, TORY J MD
JACKSON
MS
00124066
1336126911
ANDY, JOHN C MD
MERIDIAN
MS
00112019
1659395838
ANDY, ORLANDO MD
HATTIESBURG
MS
00115030
1366534851
ANGEL, MICHAEL F MD
CLARKDALE
MS
05082861
1083848329
ANGEL, WESLEY A MD
OLIVE BRANCH
MS
00118159
1316978547
ANGELO, JANET T MD
WHITFIELD
MS
00116990
1356349401
ANTHONY, BRIAN T MD
BAY SAINT LOUIS
MS
02158307
1972530632
ANTHONY, CLAUDIA W NP-C
FLOWOOD
MS
01371761
1962870253
ANTHONY, JENA W FNP
EUPORA
MS
00126022
1679641450
ANTHONY, MICHAEL D MD
STARKVILLE
MS
06629334
1245474998
ANTHONY, STEVEN S ACNP
JACKSON
MS
03171258
1700125002
ANTICI, VALERIE O CRNP
CLEVELAND
MS
03321024
1043585300
ANTILL, TROY MD
BAY SAINT LOUIS
MS
9
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125867
1215966130
ANTINNES, JAMES A MD
HATTIESBURG
MS
00254591
1477723914
ANWAR, MOHAMMAD MD
BILOXI
MS
01900556
1770562647
APPLEWHITE, GEORGE A MD
LUMBERTON
MS
02189070
1740649896
APPLEWHITE, GRACE NP
GREENWOOD
MS
00014544
1548288962
APPLEWHITE, ROBERT R MD
ELLISVILLE
MS
02632295
1033432521
APPLING, ROBERT W DPM
SOUTHAVEN
MS
08235041
1003103342
APRIL, CANDICE B DDS
TCHULA
MS
00019319
1265545875
AQUINO, ADELO MD
RULEVILLE
MS
00116968
1114909199
ARAIN, MOHAMMAD S MD
LACKEY
MS
03331365
1932340379
ARAPOS, LEONIDAS
TUPELO
MS
06174322
1295983179
ARAUJO JR, CYRILLO R MD
JACKSON
MS
00876541
1689988925
ARBOGAST, BRIAN D MD
BILOXI
MS
03374712
1669745303
ARCEMENT, CHRISTOPHER B NP
DIAMONDHEAD
MS
00118513
1831148972
ARCEO III, SALVADOR J MD
JACKSON
MS
07125378
1669835369
ARCEO IV, SALVADOR M MD
JACKSON
MS
00113217
1902834690
ARCHER, BRIAN S MD
TUPELO
MS
00019265
1962484899
ARD, MICHAEL L
LOUISVILLE
MS
02903351
1669501680
ARDOIN, RICHARD JASON PA-C
OCEAN SPRINGS
MS
00121280
1477650869
AREGHAN, GLORIA CFNP
TERRY
MS
01079820
1750339230
ARIAS, ERICH A MD
COLUMBIA
MS
08574515
1942427802
ARMSTEAD, CINDY J DO
HATTIESBURG
MS
04633792
1295021996
ARMSTEAD-WILLIAMS, CASSANDRA M MD
JACKSON
MS
00112659
1417975731
ARMSTRONG JR, RALPH C MD
GRENADA
MS
00117258
1932180635
ARMSTRONG, ANTHONY L MD
CORINTH
MS
00113821
1346238359
ARMSTRONG, CARLA M MD
TYLERTOWN
MS
06257849
1124062930
ARMSTRONG, HOLLY M NP
JACKSON
MS
07426872
1700255916
ARMSTRONG, KATHRYN J FNP
LOUISVILLE
MS
05828828
1811302847
ARMSTRONG, MARY K MSN
JACKSON
MS
10
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06857594
1770564411
ARMSTRONG, WILLIAM D DO
MERIDIAN
MS
00016776
1992729172
ARNETT, WILLIAM R MD
HATTIESBURG
MS
09587337
1366616344
ARNOLD, AMBER NP
HATTIESBURG
MS
00122511
1912927526
ARNOLD, JEANETTE NP
JACKSON
MS
00119791
1134107139
ARNOLD, KATHLEEN C
OCEAN SPRINGS
MS
08584074
1730587767
ARNOLD, KATHRYN A NP
MCCOMB
MS
07824562
1598979064
ARNOLD, PETER B MD
JACKSON
MS
09233058
1629243530
ARNOLD, STEVEN R ACNP
MCCOMB
MS
06481203
1861462178
ARNOLD, TIMOTHY L DO
MERIDIAN
MS
00122726
1245274687
ARON, JAMES MD
BATESVILLE
MS
09334865
1922025360
ARORA, NAMITA K MD
YAZOO CITY
MS
06425036
1336490713
ARRINGTON, LACIE F FNP
HOLLANDALE
MS
03453217
1942589106
ARRINGTON, LATARSHA M DMD
JACKSON
MS
00239042
1265404214
ARRIOLA, RAYMOND R MD
FULTON
MS
00124281
1639111479
ARRIOLA, RICHARD M
TUPELO
MS
00117200
1477658912
ARRIOLA, RODOLFO N
FULTON
MS
01308337
1720499668
ARTHUR, ALBERT MD
JACKSON
MS
03708341
1144663923
ARTHUR, K'ANNE C MD
JACKSON
MS
00880213
1396737813
ARTIGUE, GARY M OD
PICAYUNE
MS
00114644
1750363156
ARTIGUES, MICHAEL MD
MCCOMB
MS
00119452
1477649465
ARU, GIORGIO
JACKSON
MS
07028837
1841289030
ARZOLA, FERNANDO L MD
OXFORD
MS
03555260
1083840870
ASAMOAH, OWUSU MD
COLUMBUS
MS
04426861
1730121310
ASFOUR, MOHAMED A MD
JACKSON
MS
00064740
1710080346
ASH, WILLIAM S DDS
LUCEDALE
MS
02751071
1497767545
ASHER, ANNA C MD
FLOWOOD
MS
00772036
1790714806
ASHER, FREDERICK H MD
JACKSON
MS
00017578
1588692636
ASHFORD, WILLIAM C MD
JACKSON
MS
11
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04275520
1710242466
ASHLEY, CANDICE FNP
FLORENCE
MS
02202267
1538459458
ASHLEY, DAVID H DMD
OXFORD
MS
00121529
1104900968
ASHLEY, JON S MD
GREENWOOD
MS
04034504
1790714954
ASHLEY, KELLAN E MD
JACKSON
MS
09001077
1518309277
ASHLEY, MILES D OD
VICKSBURG
MS
00087909
1952410011
ASHLEY, WILLIAM S OD
VICKSBURG
MS
01251823
1417950023
ASHMAN, CAROL J MD
HATTIESBURG
MS
01525811
1538176847
ASHRAF, MUFEED A MD
JACKSON
MS
00119917
1619991809
ASKEW III, EDWARD MD
HATTIESBURG
MS
05488283
1740589761
ASKEW, SARA A FNP
QUITMAN
MS
08376229
1568525095
ASSINI, JOSEPH DPM
GREENWOOD
MS
05704804
1497083901
ATALLA, NADER G MD
JACKSON
MS
00012297
1720165210
ATHAR, MOHAMMAD MD
RIDGELAND
MS
05202097
1497917629
ATIANZAR, KIMBERLY C MD
HATTIESBURG
MS
01332245
1881958924
ATKINS, LINDSAY DMD
CHOCTAW
MS
04705564
1417309147
ATKINSON, AMBER K NP
CARTHAGE
MS
00123601
1407884356
ATKINSON, ANGELA M CNP
CARTHAGE
MS
03137391
1497747570
ATKINSON, GEORGE M MD
HATTIESBURG
MS
06658202
1154355428
ATKINSON, MICHELLE S FNP
CHOCTAW
MS
09225086
1497864169
ATTIPOE, NOBEL D MD
JACKSON
MS
03036240
1134427719
ATWAL, HARMINDER K NP
TUPELO
MS
05280758
1942431200
ATWOOD, AMANDA W NP
JACKSON
MS
00116538
1043249501
AUBERT JR, RICHARD J
WHITFIELD
MS
07120261
1194742734
AUCHUS, ALEXANDER P MD
JACKSON
MS
09907202
1134582240
AUJLA, KHUSH S MD
JACKSON
MS
01229263
1619150349
AULL, CODY B DO
MERIDIAN
MS
00013576
1922006279
AULTMAN, ISAAC V MD
JACKSON
MS
00853074
1326486499
AULTMAN, JEANNA L DMD
SUMRALL
MS
12
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125439
1346322880
AULTMAN, TRICIA L MD
GULFPORT
MS
02633858
1528046315
AUSEF, AMIR H MD
NATCHEZ
MS
00016780
1306881875
AUST, DENNIS W MD
CLARKSDALE
MS
08772501
1851624928
AUST, EMILY R NP
BELZONI
MS
00118139
1457443897
AUSTIN JR, WILLIAM K MD
MCCOMB
MS
00115304
1316028194
AUSTIN, JOSEPH MD
VICKSBURG
MS
00113877
1659374767
AUSTIN, SUSAN M MD
TUPELO
MS
07420783
1801848494
AUTRY, MICKIE CNFNP
JACKSON
MS
00355091
1083945497
AUXIER, MELINDA DO
PASCAGOULA
MS
07631726
1558421651
AUZENNE, GREGORY A MD
MERIDIAN
MS
00115538
1326062969
AVARA III, WILLIAM T MD
OCEAN SPRINGS
MS
08323821
1942258322
AVENT, CHERRYL M NP
JACKSON
MS
01487866
1831440759
AVERETT, COURTNEY D FNP
MERIDIAN
MS
01137289
1366477390
AVERETTE, JOHN B MD
TUPELO
MS
00119353
1447208830
AVERY, LYNDA D NP
PETAL
MS
03354772
1184841397
AVILA, AMANDA MD
TUPELO
MS
07287739
1639519069
AVUSULA, RAMACHANDRAM MD
JACKSON
MS
08077043
1720039043
AWAAD, MOHAMMED I MD
GULFPORT
MS
05050716
1245503358
AWAN, AHMED A MD
HATTIESBURG
MS
01552529
1306815576
AWH, MARK H MD
HATTIESBURG
MS
03101303
1821362385
AYCOCK, LAUREN S FNP
PETAL
MS
08325865
1396930418
AYCOCK, MONICA CNNP
JACKSON
MS
00017855
1548203946
AYCOCK, THOMAS MD
COLUMBUS
MS
00427291
1649437716
AYENI, CHRISTOPHER
NEW ALBANY
MS
03507067
1477812493
AYSOLA, HARI MD
GULFPORT
MS
00118119
1376632307
AZAR III, GEORGE J MD
HATTIESBURG
MS
05039003
1700298411
AZAR, AZNIV MD
JACKSON
MS
00121572
1851471270
AZAR, DEBORAH T MD
HATTIESBURG
MS
13
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00115228
1033159140
AZAR, NABIL J MD
GULFPORT
MS
01077341
1922203082
AZMI, SYED S MD
SOUTHAVEN
MS
07672358
1841224367
AZORDEGAN, PHILIP A MD
FLOWOOD
MS
00126926
1821194713
BABAR, SARDAR I MD
OCEAN SPRINGS
MS
05236703
1386624765
BACON, DOUGLAS R MD
JACKSON
MS
00015416
1750438446
BACON, JANICE MD
CANTON
MS
09336744
1356458012
BACON, MELISSA M DO
JACKSON
MS
03287264
1588981161
BADDORF, SARAH W MD
OLIVE BRANCH
MS
04159555
1841234879
BADER, PATRICIA W FNP
OXFORD
MS
00827012
1548423114
BADERO, OLUROTIMI J MD
JACKSON
MS
00118954
1740221316
BADR, AHMED E MD
JACKSON
MS
02173754
1477533602
BADVE, SEEMA A MD
MOSS POINT
MS
00119803
1518964972
BAGGETT MASK, BONNIE J CFNP
NEW ALBANY
MS
00016282
1982620316
BAGGETT, HORACE H MD
HATTIESBURG
MS
00124054
1164487641
BAGINGITO, EDMUND M MD
HATTIESBURG
MS
01339370
1306100771
BAGLEY, JONATHAN P MD
JACKSON
MS
08085016
1558306019
BAGWELL, MICHAEL B DO
TUPELO
MS
09570029
1861410904
BAHADUR, RAINNA P MD
BILOXI
MS
01485213
1437240215
BAHL, ALEXANDRIA A OD
CANTON
MS
00120721
1447286612
BAHRO, ABDUL G MD
JACKSOM
MS
07001201
1740360601
BAIG, HARRIS R MD
JACKSON
MS
00660151
1255441770
BAILEY JR, KENNETH A
JACKSON
MS
09635708
1386877561
BAILEY, ALLISON M FNP
ECRU
MS
04302591
1003161373
BAILEY, AMY E FNP
AMORY
MS
09380064
1861803223
BAILEY, BEATRICE L NP
RULEVILLE
MS
03922560
1518271873
BAILEY, CHARLES W DMD
CORINTH
MS
08124226
1013941970
BAILEY, ELIZABETH K ACNP
TUPELO
MS
00158064
1447431465
BAILEY, JENNIFER C MD
HATTIESBURG
MS
14
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00117625
1427063791
BAILEY, JOHN D MD
PASCAGOULA
MS
03484003
1700046414
BAILEY, KIZZY L MD
HATTIESBURG
MS
00115017
1487609871
BAILEY, LISA M
HATTIESBURG
MS
05781061
1669826947
BAILEY, SUMMER S MD
JACKSON
MS
02934501
1417118548
BAILEY, THOMAS J MD
HATTIESBURG
MS
06758508
1578793220
BAILEY, VALERIE C NP
MADISON
MS
08587072
1578878344
BAIN, JENNIFER L DMD
JACKSON
MS
07336711
1437238938
BAIN, LAQUITA G FNP
CORINTH
MS
00116610
1043439854
BAINE, RODNEY MD
CLARKSDALE
MS
00060127
1396748067
BAINES, GENE M DMD
GREENWOOD
MS
04539310
1255713467
BAINS, DARCY J MD
JACKSON
MS
06432097
1700020278
BAINS, KARANPREET MD
CLARKSDALE
MS
08136252
1578640959
BAIRD, PAMELA L NP
COLUMBUS
MS
06628570
1518028075
BAJESTANI, SAEED N MD
JACKSON
MS
09180362
1891083978
BAJWA, MANDEEP MD
JACKSON
MS
05127841
1104141712
BAKDASH, TARIF MD
JACKSON
MS
09003351
1548347693
BAKER JR, MARTIN H DDS M
HATTIESBURG
MS
06974744
1457513202
BAKER, DONALD E MD
JACKSON
MS
08508251
1134150006
BAKER, JANELLE R NP
NATCHEZ
MS
07559547
1881844090
BAKER, JAPHETH J DO
CORINTH
MS
02108317
1639119589
BAKER, JUSTIN T MD
JACKSON
MS
00060249
1558577841
BAKER, MAC L DDS
BROOKHAVEN
MS
07901390
1982970166
BAKER, MARGARET H MD
CORINTH
MS
00123141
1043236722
BAKER, MICHAEL L
ROLLING FORK
MS
00012038
1013011303
BAKER, STEPHEN W MD
GULFPORT
MS
06609743
1982801585
BAKHTAWAR, HUMAYUN MD
HATTIESBURG
MS
01973391
1336198100
BALDER, DONALD A MD
GULFPORT
MS
01075312
1932409083
BALDWIN, BARBRETTE A MD
WEST POINT
MS
15
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00117392
1235279688
BALDWIN, NATHAN W MD
BOONEVILLE
MS
03053543
1487778239
BALDWIN, ZACHARY K MD
JACKSON
MS
01934596
1154608222
BALES, WENDY L APMHN
LAUREL
MS
00671542
1861442436
BALFOUR, ERIC L MD
JACKSON
MS
00117497
1760473185
BALFOUR, HARVEY B MD
GULFPORT
MS
00115541
1851473854
BALL, DAVID A MD
BATESVILLE
MS
00018294
1740272947
BALL, DAVID K MD
JACKSON
MS
00013476
1225020175
BALL, GEORGE C MD
JACKSON
MS
06807331
1770593014
BALL, KENNETH C MD
BRANDON
MS
02229397
1588743314
BALL, PATRICK A DO
SOUTHAVEN
MS
03937072
1578010088
BALL, RAMONA M FNP
JACKSON
MS
05180024
1104200682
BALL, SHONVE L NP
TUPELO
MS
02587868
1508216888
BALL, TRAVIS P DMD
LAUREL
MS
00126597
1528153558
BALLARD, AMY M PA
JACKSON
MS
06809362
1215013073
BALLARD, DEANNA D CFNP
NATCHEZ
MS
00353278
1841613684
BALLARD, JEFFREY S NP
TUPELO
MS
07625012
1174818389
BALLARD, KELI W MSNA
JACKSON
MS
05534513
1437381076
BALLARD, MONICA A OD
PONTOTOC
MS
05300066
1366739054
BALLARD, RICHARD D MD
JACKSON
MS
00116628
1821090549
BALLARD, ROBERT C
RIPLEY
MS
03777066
1275836991
BALLARD, SHANNON L NP
TUPELO
MS
00660016
1558443481
BALTHIS, LENORA G DMD
RIDGELAND
MS
00122260
1366438772
BALTHROP, ERICA R MD
CLARKSDALE
MS
00016214
1083647770
BALZLI, JOSEPH T MD
MERIDIAN
MS
05430527
1164677845
BAMGBELU, OLUKAYODE A MD
JACKSON
MS
07977047
1790063857
BANDA, KEERTHI MD
HATTIESBURG
MS
00125682
1174555247
BANDEALY, AMIN MD
OLIVE BRANCH
MS
02678231
1316359789
BANG, TERRY L MD
JACKSON
MS
16
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00115199
1043212616
BANISTER, PAMELA K MD
OCEAN SPRINGS
MS
05706349
1992158281
BANKS, JACQUELINE B FNP
JACKSON
MS
03784068
1346593035
BANKS, KATHY NP
OLIVE BRANCH
MS
00121754
1811932064
BANKS, MICHELLE D
VICKSBURG
MS
09750037
1063771350
BANKS, SHIMEKA L MD
FLOWOOD
MS
00110971
1164464939
BANQUER, KIRK J MD
HATTIESBURG
MS
00660237
1528084829
BAPTIST-WILSON, BETTYE R DDS
SOUTHAVEN
MS
04685716
1104894880
BARAKAT, RUBA F MD
MERIDIAN
MS
07952511
1295937183
BARANANO, ANNE E MD
BILOXI
MS
07108353
1861843690
BARBER, PATRICIA A FNP-C
GREENVILLE
MS
00121800
1942239090
BARBIERI, JR., ROCCO A MD
HATTIESBURG
MS
00120357
1578594586
BARCLAY, VIVEK
LAUREL
MS
03402541
1548286149
BAREFOOT, WILLIAM C ACNP
JACKSON
MS
05472883
1528276284
BARFIELD, MATTHEW Q DO
PASCAGOULA
MS
08423212
1336155399
BARHAM, BROOKS O MD
JACKSON
MS
00013290
1457367401
BARHAM, ED D
JACKSON
MS
00019827
1780740183
BARKER, JEAN MD
GREENVILLE
MS
05483521
1992790463
BARKER, KEVIN B MD
HATTIESBURG
MS
02724813
1952609802
BARKER, MORGAN L FNP-B
TUPELO
MS
02230726
1528327319
BARKER, ROBERT C DPM
HATTIESBURG
MS
00880079
1184797870
BARKER, WILLIAM F OD
GULFPORT
MS
09306567
1588095251
BARKLEY, LORI NP
TUPELO
MS
05736065
1679635320
BARKLEY, PHILLIP J DMD
JACKSON
MS
05736065
1679635320
BARKLEY, PHILLIP J DMD
CLARKSDALE
MS
00116745
1376540229
BARKLEY, THOMAS F MD
NEW ALBANY
MS
00115734
1083663876
BARKSDALE, BRYAN MD
JACKSON
MS
00119633
1043244510
BARLOW, CHRISTINA L MD
JACKSON
MS
00122968
1740203199
BARMADA, HAZEM MD
OCEAN SPRINGS
MS
17
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02186024
1144244351
BARNARD, BARBARA S DO
HATTIESBURG
MS
09832783
1275513046
BARNES, CARLETTA Y DMD
HATTIEBURG
MS
03976051
1164978151
BARNES, CHANELL C CPNP-
COLUMBUS
MS
00880058
1083783963
BARNES, CHARLES E OD
MCCOMB
MS
02581853
1427594480
BARNES, CHRISTINA NP
GULFPORT
MS
00118617
1972562114
BARNES, JACKIE CFNP
CLEVELAND
MS
00121823
1366523284
BARNES, JENNIFER O CFNP
BALDWYN
MS
00114084
1205865680
BARNES, JOHN R M.D.
VICKSBURG
MS
00660146
1558380105
BARNES, LAURIE A DMD
BRANDON
MS
00125356
1962440230
BARNES, MARIANNE MD
TUPELO
MS
00019091
1558396010
BARNES, PHILLIP L DO
BILOXI
MS
04954064
1295970721
BARNES, ROLANDO S DO
BILOXI
MS
07958277
1902294093
BARNES, TANGULAR M FNP-C
BEAUMONT
MS
05986876
1538521901
BARNES-WOODS, CONSTANCE P MD
JACKSON
MS
09039862
1841271293
BARNETT, CHRISTY S MD
JACKSON
MS
00112966
1689767782
BARNETT, DAVID E MD
JACKSON
MS
03457251
1891197117
BARNETT, JOANNA P NP
RULEVILLE
MS
04531751
1669793295
BARNETT, MEAGHAN D MD
JACKSON
MS
00126770
1669450425
BARNETT, MELISSA L
TUPELO
MS
07929861
1184633612
BARNETT, ROBERT E MD
NEW ALBANY
MS
03481226
1376659193
BAROT, NAVIN V MD
GULFPORT
MS
00123206
1487683231
BAROUDI, BASSAM R MD
GULFPORT
MS
02453236
1396184909
BAROWKA, SARAH MD
TUPELO
MS
06136091
1598861759
BARR, FREDERICK E MD
JACKSON
MS
02709024
1356545677
BARR, JENNIFER S MD
JACKSON
MS
09335765
1215300736
BARR, KERI W PMHNP
MERIDIAN
MS
09332725
1124409388
BARRAS, ANGELA M DMD
GULFPORT
MS
00122947
1124063920
BARRAZA, KENNETH R MD
FLOWOOD
MS
18
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06627853
1881917987
BARRENTINE, KRISTY W NP
BILOXI
MS
08107094
1730490046
BARRETT, ALLISON C MD
FLOWOOD
MS
05034089
1770781338
BARRETT, AUSTIN M MD
JACKSON
MS
06903314
1265640577
BARRETT, BRET J MD
JACKSON
MS
00115769
1386632552
BARRETT, GENE R MD
JACKSON
MS
00114873
1518949262
BARRETT, GLENDA R
DECATUR
MS
00122795
1811929193
BARRETT, HARRIS G MD
MOSS POINT
MS
00115079
1932100898
BARRETT, HOSHALL S MD
GULFPORT
MS
00120110
1609847441
BARRETT, PAUL WESLEY CFNP
COLUMBUS
MS
08208728
1093121469
BARRICK, CHRISTY G MSN
JACKSON
MS
02985341
1770998395
BARRON, DOUGLAS L
TUPELO
MS
07827057
1245435726
BARRON, LAURA A MD
FLOWOOD
MS
01380563
1255576377
BARRON, MARK T MD
BROOKHAVEN
MS
00116872
1548202385
BARROW, III, VERNON W
TUPELO
MS
00087901
1245386481
BARRY MARSHALL OD
GULFPORT
MS
01572011
1669784815
BARRY, LAUREN E MD
JACKSON
MS
03332816
1609178532
BARRY, LESLIE L NP
JACKSON
MS
00017521
1497828529
BARTEE SR, HARRY A MD
LEXINGTON
MS
07871794
1467433623
BARTEE, HARRY A MD
CLEVELAND
MS
00953578
1477932770
BARTLETT, ANDREW J MD
JACKSON
MS
04583570
1871972711
BARTLEY III, GEORGE W MD
JACKSON
MS
00013757
1770519142
BARTLEY-RICE, DEBRA D
CANTON
MS
05104354
1346408291
BARTON III, WILLIAM H MD
TUPELO
MS
05901332
1073661419
BARTRAN, LORI H NP
LAUREL
MS
04656744
1104266477
BASHIR, FERHAD MD
JACKSON
MS
00660371
1275673592
BASINGER, DAVID R DMD
GRENADA
MS
03309201
1407052228
BASKARARAJAN, VENKATASUBRAMAN MD
HATTIESBURG
MS
08803511
1306192349
BASKIN, LAWANDA W C-FNP
NATCHEZ
MS
19
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00121888
1851398309
BASLER, BONNIE N MD
TUPELO
MS
00520851
1366604100
BASS, ERICA H MD
JACKSON
MS
02880272
1770669020
BASS, ROGER K DMD
COLLINS
MS
06436218
1073920716
BASS, WILLIAM NP
NATCHEZ
MS
07970092
1053609586
BASSI, ROOPSI MD
JACKSON
MS
09481295
1487817854
BASSILA, JEAN CLAUDE N MD
GREENVILLE
MS
00110157
1225133978
BATEMAN, KYLE S MD
BROOKHAVEN
MS
08759071
1114016144
BATEN, JOHN M MD
FLOWOOD
MS
04138318
1528398054
BATES, BECKY L WHNP
JACKSON
MS
00620586
1891180626
BATES, REBECCA N MD
JACKSON
MS
02626082
1396909156
BATH, KARAN S MD
SOUTHAVEN
MS
09683029
1225476641
BATLIVALA, CARLA M MSN
JACKSON
MS
00432556
1730278391
BATLIVALA, SAROSH P MD
JACKSON
MS
08807707
1104840958
BATSON, BRYAN N MD
HATTIESBURG
MS
08620771
1609835420
BATSON, HAROLD H MD
CORINTH
MS
06420342
1770731689
BATSON, SHUNTAYE D MD
JACKSON
MS
00017380
1891840492
BATTLE, WILLIAM R
JACKSON
MS
04174306
1225129992
BAUCUM, DONNA L FNP
LAUREL
MS
00660372
1548275100
BAUER, FREDERICK S DMD
CORINTH
MS
00119617
1285728626
BAUGH, BRADLEY R
CLEVELAND
MS
07684779
1427286236
BAUTISTA, LEODY C MD
TUPELO
MS
07156851
1871801795
BAVARIYA, ANKIT J BDS M
SOUTHAVEN
MS
00125904
1811079544
BAXTER, DEBRA L CFNP
GREENVILLE
MS
08675571
1629365358
BAYLES, JOANNA DO
BAY ST LOUIS
MS
06776019
1467555771
BAYLIS, THOMAS B MD
HATTIESBURG
MS
03975706
1164436184
BAYMILLER, SCOTT E MD
BATESVILLE
MS
00134216
1760782981
BAYS, KATRINA CFNP
GRENADA
MS
05355091
1972604650
BAZZONE, VICTOR T MD
GULFPORT
MS
20
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07483549
1194090209
BEACH, GREGORY L NP
COLUMBUS
MS
04330519
1669670360
BEACHAM, TIMOTHY J MD
JACKSON
MS
04280894
1578832598
BEAM, JOANNE L NP
OXFORD
MS
00010503
1932190774
BEAMAN, JOHN M MD
RICHTON
MS
03859763
1558465120
BEAMON, VERNON F DMD
GULFPORT
MS
04427852
1568658458
BEAN, CHRISTOPHER M MD
JACKSON
MS
00026087
1861600595
BEAN, CYNTHIA M MD
JACKSON
MS
00019404
1528017282
BEAR, LESLIE H MD
JACKSON
MS
00119634
1003834052
BEARD, GAIL
MERIDIAN
MS
00116575
1629093018
BEARD, HERMAN R
FLOWOOD
MS
03825813
1396032983
BEARD, WALTER L MD
JACKSON
MS
03657240
1831405448
BEARDEN, JAMES W OD
CANTON
MS
00060448
1356440135
BEARDEN, KATIE DDS
BATESVILLE
MS
02177715
1144620592
BEARDEN, KELLI R NP
RULEVILLE
MS
06033800
1285741983
BEARRY, JOHN MD
GREENVILLE
MS
00111151
1154321354
BEASLEY, ETHEL S MD
CHOCTAW
MS
00017613
1689696817
BEASLEY, JAMES M MD
LAUREL
MS
03276372
1508860214
BEASLEY, JASON G
COLLINS
MS
03622558
1689003873
BEASLEY, SARAH K CNP
JACKSON
MS
00188819
1073820338
BEASLEY, STEPHANIE M FNP
CALEDONIA
MS
00276815
1538393905
BEASLEY, THOMAS B MD
OLIVE BRANCH
MS
04057773
1336504778
BEASLEY, TIA M PA-C
SOUTHAVEN
MS
03527020
1114238425
BEASON, KEVIN L MD
PHILADELPHIA
MS
01800074
1699183772
BEATTY, DAVID P OD
BRANDON
MS
00880181
1043394208
BEATY, STEVEN C OD
FULTON
MS
04508000
1306011291
BEAUCHAMPS, LAURA S MD
JACKSON
MS
03304364
1861680670
BEAVER, LESA NP
SOUTHAVEN
MS
08101262
1790849404
BEAVERS, NATHAN K DMD
MADISION
MS
21
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118573
1093769648
BEAZLEY, WILLIAM W DO
PICAYUNE
MS
09438883
1114120474
BECK, JASON D MD
PASCAGOULA
MS
00118711
1033157672
BECKER, ROBERT V
TUPELO
MS
05431572
1073934576
BECKHAM, HANNAH E NP
CORINTH
MS
00013803
1174564397
BECKHAM, JAMES R MD
GREENVILLE
MS
04922530
1285033571
BECKUM, JOELI CNP
WATER VALLEY
MS
00123578
1225242100
BECKUM, MICHAEL T CFNP
GRENADA
MS
00672559
1699972596
BECKWITH, AMANDA B DO
OXFORD
MS
08650772
1609864974
BECKWITH, SHARA CFNP
FLOWOOD
MS
05825798
1932113404
BEDDINGFIELD, JASON M OD
LAUREL
MS
01254848
1063898633
BEDELLS, KAREN H NP-C
PEARL
MS
07501353
1447682729
BEDWELL, STEFFANY RN NP
HATTIESBURG
MS
01857813
1629063003
BEEBE, CHRISTIAN A MD
CHOCTAW
MS
00112681
1881795235
BEEBE, DIANE K MD
JACKSON
MS
08221043
1497071146
BEEBE, MICHAEL J MD
SOUTHAVEN
MS
00110443
1982999314
BEEMAN, STEPHEN K
MANTACHIE
MS
00487016
1760654990
BEEMIDI, VIKRAM R MD
CLARKSDALE
MS
03237772
1568428605
BEER, RODOLFO S MD
BATESVILLE
MS
07757360
1922056159
BEEZLEY JR, ALVIN R DO
CALEDONIA
MS
01831026
1457799918
BEGOLE, MARY J MD
TUPELO
MS
08906229
1669624078
BEGUM, MUBEENA MD
BILOXI
MS
02252773
1508170853
BEGUM, RAHMATH U MD
MERIDIAN
MS
01872845
1578975181
BEHLEN, LAURA C MD
JACKSON
MS
00120119
1932111325
BEHR, CHRISTOPHER L MD
WEST POINT
MS
03871775
1174546345
BEISEL, BERTHOLD
COLUMBIA
MS
05876264
1235683665
BEISEL, LORI S FNP-B
FOXWORTH
MS
06050013
1154483394
BEISSEL, CANON J MD
GREENWOOD
MS
05083526
1568492478
BELAGA, MARSHALL E MD
BRANDON
MS
22
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03351207
1902032964
BELENCHIA, CYNTHIA R CFNP
RULEVILLE
MS
00115507
1700868452
BELENCHIA, RUSSELL E
UNION
MS
00880132
1346211745
BELK, CRAIG R
GULFPORT
MS
00122356
1972527372
BELKNAP, AMOS MD
PEARL
MS
00259367
1285899229
BELKNAP, CHARLES L DMD
HATTIESBURG
MS
03179741
1124180567
BELKNAP, JOHN D MD
JACKSON
MS
04383568
1467543611
BELL, AVA H M.D.
HATTIESBURG
MS
04450522
1053356410
BELL, BLANCHE M CFNP
WOODVILLE
MS
03975705
1225190382
BELL, CHRIS M ACNP
TUPELO
MS
00125939
1235249376
BELL, DAVID W MD
TUPELO
MS
00221037
1083653257
BELL, DEBRA NP
CLINTON
MS
01706092
1508077587
BELL, ERIC M MD
MERIDIAN
MS
02284095
1811194772
BELL, JERICHO L
JACKSON
MS
05202031
1417355694
BELL, KAMI E NP
GULFPORT
MS
05332075
1841554227
BELL, KRISTEN S MD
JACKSON
MS
00657827
1003014440
BELL, LINDA C NP
BILOXI
MS
00117713
1750317400
BELL, NKEBA I FNP
JACKSON
MS
00608818
1619171188
BELL, PARKER L DO
HATTIESBURG
MS
09082063
1871939652
BELL, SARA MD
GREENWOOD
MS
00119012
1578639183
BELL, STEPHEN W
PASCAGOULA
MS
00119670
1164470720
BELL, WILLIAM J MD
CORINTH
MS
00119510
1104808856
BELL, WILLIAM S
MERIDIAN
MS
00110262
1861549933
BELL, WILLYE A
JACKSON
MS
00121619
1609883446
BELLAN III, JOHN A MD
JACKSON
MS
06085387
1346521119
BELLIPANNI, MATTHEW B OD
INDIANOLA
MS
00036889
1457660664
BENDER, LESLIE D MD
MERIDIAN
MS
00660139
1538219043
BENDER, TERESA M DMD
JACKSON
MS
00114493
1356302574
BENEFIELD, BOYD P MD
GULFPORT
MS
23
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00015674
1386636694
BENEFIELD, DONALD W MD
GULFPORT
MS
05870006
1942555438
BENGE, JENNA C MSN
JACKSON
MS
00880092
1881812709
BENIGNO, JAMES B OD
PASS CHRISTIAN
MS
00880093
1558395806
BENIGNO, KIMBERLY R OD
BILOXI
MS
01682232
1447547047
BENNETT, ALLISON D MD
STARKVILLE
MS
09478561
1538471842
BENNETT, BRETT A MD
JACKSON
MS
02700224
1336486422
BENNETT, COURTNEY A PMHNP
MERIDIAN
MS
07051211
1144547555
BENNETT, ERIN S CNP
VICKSBURY
MS
00116918
1871596130
BENNETT, JAMES D MD
COLUMBUS
MS
03650034
1760426670
BENNETT, JAMES G MD
JACKSON
MS
00125994
1538259478
BENNETT, JAMES T MD
GULFPORT
MS
04323309
1659682094
BENNETT, JANELLE A MD
JACKSON
MS
00123894
1447210901
BENNETT, JOSEPH S
GREENWOOD
MS
00119359
1043254253
BENNETT, KENNETH R
JACKSON
MS
07759251
1174829501
BENNETT, KINYATTA S DMD
GULFPORT
MS
00123607
1548201403
BENNETT, MELINDA J NPA
HATTIESBURG
MS
09959571
1184678716
BENNETT, MIRANDA L FNP-C
OXFORD
MS
00118967
1407878747
BENNETT, PATRISE W M.D.
JACKSON
MS
00880083
1700986452
BENNETT, ROBIN D OD
NEW ALBANY
MS
01708778
1629166137
BENNETT, RODERICK N MD
HATTIESBURG
MS
01986051
1295117091
BENNETT, SENTORITA APRN
OLIVE BRANCH
MS
06621091
1275970725
BENNETT, SONDRA M PMHNP
CORINTH
MS
00121404
1730166307
BENNETT, WESLEY S MD
MERIDIAN
MS
00675527
1801104526
BENNETT, YOLANDA F FNNP
WHTFIELD
MS
09434720
1710084678
BENNETT-THOMPSON, JEAN NP
GULFPORT
MS
01830579
1033572458
BENOIT, JEREMY J DO
JACKSON
MS
00854025
1457591570
BENSLER, JAMES M MD
JACKSON
MS
00014987
1720092547
BENSON, CHRIS H MD
HATTIESBURG
MS
24
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06236897
1982648382
BENSON, JEANNE R FNP
CORINTH
MS
08508573
1316144280
BENTLEY, MATTHEW B DO
JACKSON
MS
00120423
1114931300
BENTON, DAMEA B
HATTIESBURG
MS
09907750
1497747661
BENTON, GAIL M DDS
JACKSON
MS
00120425
1538173398
BENTON, LOUIS W M.D.
HATTIESBURG
MS
09202378
1669465688
BENTON, MARY S MD
SOUTHAVEN
MS
00124670
1437151859
BENTON, SCOTT A MD
JACKSON
MS
06279075
1780666313
BENTON, TODD A MD
HATTIESBURG
MS
00012898
1720195860
BENUS, JOHN W DPM
PASCAGOULA
MS
02553563
1255332458
BENZING, JEFFREY DPM
BAY ST LOUIS
MS
08908534
1225020498
BENZING, TRACY MD
DIAMONHEAD
MS
02880728
1124175013
BERCH, BARRY R MD
JACKSON
MS
08037078
1750743670
BERCH, MARLAINA G MD
JACKSON
MS
00060303
1285719468
BERG, BRIAN C
CHOCTAW
MS
00018061
1114901063
BERG, ROBERT J MD
MERIDIAN
MS
02456089
1609883347
BERGER, BRAD Z MD
GULFPORT
MS
05953545
1114034543
BERGER, INES H MD
JACKSON
MS
04155201
1194962944
BERGIN, PATRICK F MD
JACKSON
MS
00014739
1205941747
BERNADAS, RONALD P M.D.
GULFPORT
MS
00114941
1700844875
BERNARDO, KERRY L MD
HATTIESBURG
MS
00112062
1255424727
BERNHEIM, PETER J MD
GULFPORT
MS
07752582
1518915008
BERNSTEIN, BENJAMIN MD
NEW ALBANY
MS
06439090
1992024459
BERRY, DAVID M MD
MERIDIAN
MS
00119247
1679688113
BERRY, JAMES M MD
TUPELO
MS
04379857
1821420712
BERRY, JARRAD M OD
PICAYUNE
MS
07234531
1356638977
BERRY, JOHN H MD
HATTIESBURG
MS
08087589
1790981660
BERRY, MICHAEL A MD
COLUMBUS
MS
05974037
1154799625
BERRY, REGINA W CNP
JACKSON
MS
25
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00015083
1942250469
BERRY, ROBERT H DO
JACKSON
MS
00116846
1841305679
BERRY, SCOTT M MD
JACKSON
MS
02829214
1023372588
BERRY, TEDDI H MD
JACKSON
MS
06757777
1285043612
BERRY, VANESSA N FNP
BOONEVILLE
MS
00017218
1346340981
BERRYHILL JR, GUS D MD
CLARKSDALE
MS
08136725
1689630204
BERRYMAN, CHARLES R MD
WAYNESBORO
MS
09133044
1518130392
BERTEAU, CRAIG D MD
MCCOMB
MS
00118728
1295845444
BERTOLET, BARRY D MD
TUPELO
MS
04370211
1588752810
BERTSCHLER, ERICA L MSN
LEXINGTON
MS
00016927
1699744482
BERTUCCI, GREGORY E MD
BILOXI
MS
07088395
1194793299
BERTUCCI, PHILIP L MD
GULFPORT
MS
09974231
1710992409
BERUK, DJUANA M DDS
GREENVILLE
MS
04259866
1497042030
BESINGER, ROBERT W MD
FLOWOOD
MS
00125119
1578504320
BESS, MICHAEL D D.O.
NATCHEZ
MS
00119879
1679554323
BESSELIEVRE, TODD R
GREENWOOD
MS
06079813
1164815007
BESSONETTE, ELLANIE L AGACN
MCCOMB
MS
08874337
1356742894
BESTER, DOROTHY R CNP
MACON
MS
00121860
1528178415
BETHALA, CYRIL V MD
GULFPORT
MS
00122367
1659333052
BETHALA, YASHASHREE L MD
BILOXI
MS
09855207
1568462141
BETHEA, JOHN W MD
JACKSON
MS
02655503
1265744437
BETHEA, LAUREN A MD
HATTIESBURG
MS
05035265
1376861849
BETTIN, CLAYTON C MD
SOUTHAVEN
MS
03184271
1669486692
BEVARD, BRENT D DO
HATTIESBURG
MS
00126440
1215909171
BEVERING, CARL MD
TUPELO
MS
05551805
1558411207
BEVILACQUA, SILVIA A MD
MERIDIAN
MS
01487036
1841315546
BEVILL, KRISTEN B MD
FLOWOOD
MS
08606341
1508232067
BEW, KATRINA NP
HORN LAKE
MS
02952843
1790796084
BHADRIRAJU, SRINIVAS MD
GREENWOOD
MS
26
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00126102
1700814829
BHAGAT, RAJESH MD
JACKSON
MS
03257003
1083970123
BHANDARI, SAHITYA MD
NATCHEZ
MS
07474898
1417246877
BHANDARI, SHIV R MD
TUPELO
MS
06829214
1548572274
BHANDARI, UMESH MD
HATTIESBURG
MS
03736028
1932337060
BHARTIA, ADITYA KUMAR MD
BILOXI
MS
00119085
1891826087
BHARWANI, SALIM MD
HATTIESBURG
MS
00121789
1942237953
BHATT, ABHAY J
JACKSON
MS
05608875
1235335456
BHUPATHI, SATYA V MD
JACKSON
MS
05306238
1568495869
BIBB, KIMBERLY A MD
RIDGELAND
MS
08659271
1457668162
BICKHAM, TERRI J NP
HATTIESBURG
MS
00117572
1275517476
BICKNELL, BENNETT W MD
OLIVE BRANCH
MS
05000770
1659391423
BIDWELL, JOSIE H CFNP
JACKSON
MS
00019223
1144259235
BIGELOW, CAROLYN L
JACKSON
MS
06407757
1376762187
BIGELOW, TOD A DDS
LIBERTY
MS
08001011
1629021258
BIGGS, JACK C
OLIVE BRANCH
MS
05089890
1679702716
BIGLANE, JOHN B MD
HATTIESBURG
MS
00112506
1396776258
BIGLER, STEVEN A MD
JACKSON
MS
00178228
1225234164
BILAL, SIDDEEQAH D MD
PURVIS
MS
03736718
1194809822
BILBREW, DAPHNE M MD
FLOWOOD
MS
03882551
1427492693
BILLINGTON, ANIKIA S NP
OLIVE BRANCH
MS
00017563
1154349926
BILLINGTON, WILLIAM MD
WEST POINT
MS
06203599
1023422052
BILLS III, ROBERT C D.M.D
NEW ALBANY
MS
00064711
1992758650
BILLS JR, ROBERT C DDS
HATTIESBURG
MS
00117022
1598737215
BILLUPS III, WILLIAM A MD
MERIDIAN
MS
00013447
1972576312
BILLUPS JR, WILLIAM A MD
MERIDIAN
MS
04050575
1568867455
BINGHAM, KAYLORA L FNP-C
BROOKLYN
MS
03937051
1427444116
BINGHAM, PAMELA D PA
BRANDON
MS
07683525
1477521532
BINGHAM, RONALD C
SOUTHAVEN
MS
27
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08932797
1306945316
BIRD, RYAN T MD
HATTIESBURG
MS
04256553
1013259555
BIRDSONG, SARA S MD
PASCAGOULA
MS
08156367
1023480944
BIRGE, JAMIE L CNP
CLARKSDALE
MS
00018147
1881702710
BISHOP, ANDREW C MD
JACKSON
MS
09125336
1528220233
BISHOP, CURTIS M DMD
HATTIESBURG
MS
01751273
1699851733
BISHOP, JAMES C DDS
COLLINS
MS
00122139
1679596613
BISHOP, KELLEY M MD
JACKSON
MS
09372747
1912214669
BISHOP, LISA NP
BATESVILLE
MS
05531862
1609323450
BISHOP, MEGAN R NP
FOREST
MS
00119588
1174567465
BISHOP, PHYLLIS
JACKSON
MS
05029840
1093132854
BISHOP, RUTH L NP
GULFPORT
MS
08601532
1831144039
BISWAS, DEBASHIS MD
SOUTHAVEN
MS
08303857
1821267998
BITAR, IMAD MD
HATTIESBURG
MS
08107236
1790988087
BLACK IV, CHARLES H DO
CANTON
MS
00118736
1316939358
BLACK, ARTHUR D MD
PASCAGOULA
MS
07401794
1730199290
BLACK, BRUCE T MD
MADISON
MS
05788729
1154548972
BLACK, DAVID A MD
JACKSON
MS
09477305
1508029083
BLACK, JASON L
MERIDIAN
MS
00121526
1225079825
BLACK, JOHN L MD
SOUTHAVEN
MS
07373728
1083843544
BLACK, NAN M DDS
JACKSON
MS
05637711
1912166703
BLACK, WILLIAM H MD
JACKSON
MS
00900834
1770747081
BLACKBURN, SCOTT DO
GULFPORT
MS
00118021
1336180231
BLACKLEDGE, DEBRA L FNP
LAUREL
MS
03504265
1659683266
BLACKLEDGE, DOUGLAS H MD
JACKSON
MS
00115523
1497798615
BLACKLEDGE, THOMAS R MD
MAGEE
MS
00087010
1760451595
BLACKMER, LORI L OD
PICAYUNE
MS
05323701
1194834747
BLACKSTON, JOSEPH W MD
JACKSON
MS
09030251
1578884466
BLACKWELL, ASHLEY D DPM
CLINTON
MS
28
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06606778
1811217409
BLACKWELL, BLEN D
HATTIESBURG
MS
01538051
1982964565
BLACKWELL, CHRISTOPHER W FNP
TYLERTOWN
MS
09257847
1831170208
BLACKWELL, JOHN R MD
MERDIAN
MS
08076764
1255751525
BLACKWELL, KORY W MD
HATTIESBURG
MS
00115094
1316906548
BLACKWOOD, DONALD J MD
CLEVELAND
MS
00114916
1558456764
BLACKWOOD, MARK E
CLEVELAND
MS
09289359
1336309921
BLADSACKER, NANCY G CFNP
BILOXI
MS
07989353
1902835234
BLAIR, GEORGE J MD
HATTIESBURG
MS
00123998
1184719502
BLAIR, PATRICIA S NP
BATESVILLE
MS
00060307
1285722009
BLAIR, STEPHEN H
IUKA
MS
00015289
1558330415
BLAKE JR, THOMAS H MD
LAUREL
MS
00116141
1427072966
BLAKE, KENDALL T MD
JACKSON
MS
00122620
1023049335
BLAKE, ROGER MD
CLEVELAND
MS
00608516
1942402029
BLAKENEY, DANIELLE D MD
LAUREL
MS
08222360
1326457151
BLAKENEY, LACEY M FNP
HATTIESBURG
MS
00122059
1891709572
BLAKENEY, SUSAN
HATTIESBURG
MS
00113879
1033175161
BLALACK, JEFFREY A MD
OLIVE BRANCH
MS
02580821
1295965614
BLALACK, VIRGINIA A MD
GULFPORT
MS
00124443
1730118696
BLALOCK, HAROLD J
JACKSON
MS
07321871
1568745966
BLALOCK-PERKINS, NORALYN C CFNP
SUMMIT
MS
00118752
1598853087
BLANCHARD, EARL J MD
RIDGELAND
MS
00124393
1992719777
BLANCHARD, KEVIN P
HATTIESBURG
MS
07989506
1740212737
BLANCHARD, SUSAN A MD
LONG BEACH
MS
00124764
1770595084
BLANCHARD, SYLVIA O CFNP
TUPELO
MS
03651200
1184778508
BLANCO, ARTURO E
FLOWOOD
MS
09953206
1629329289
BLANKENSHIP, CARMIE S CFNP
SARDIS
MS
04476359
1801051925
BLANKS, ADAM K NP
JACKSON
MS
00112507
1063452639
BLANKS, THOMAS S M.D.
GULFPORT
MS
29
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01527542
1730538539
BLANTON, BRANDY CFNP
STARKVILLE
MS
BLASSINGAME, KATHERINE R NP-C
NEW ALBANY
MS
06233735
Jun 11, 2017
05935300
1255340949
BLAUDEAU, ERICK MD
JACKSON
MS
02272591
1538430244
BLAVO, DELALI O DO
CORINTH
MS
00012380
1750373809
BLAYLOCK, DARRELL N MD
GREENVILLE
MS
02784012
1609178094
BLAYLOCK, KRISTA B FNP
SUMMIT
MS
05687835
1225013527
BLECKER, UWE MD
JACKSON
MS
00125048
1508962101
BLESSE, LISA G FNP
HATTIESBURG
MS
08577001
1174568752
BLETHEN, WENDY N
JACKSON
MS
00117064
1508890765
BLEVENS, ALEXANDER D MD
VANCLEAVE
MS
06002844
1477524502
BLEWETT, CHRISTOPHER J MD
JACKSON
MS
00116228
1336207547
BLOOME, ROBERT S DO
BILOXI
MS
01186021
1518115971
BLOSSOM, AMY P MD
NEW ALBANY
MS
03670007
1477648087
BLOSSOM, BENJAMIN D MD
TUPELO
MS
06308359
1407235617
BLOSSOM, JONATHAN A MD
JACKSON
MS
00233372
1477991552
BLOSSOM, MARY C DMD
MORTON
MS
00118379
1992793897
BLOUNT III, JAMES J
PICAYUNE
MS
02154523
1831136175
BLOUNT, PHILIP J MD
FLOWOOD
MS
00081001
1942524749
BLOUNT, REBECCA G FPMHN
PICAYUNE
MS
00954329
1992859946
BLOUNT, REBECCA S NP
MERIDIAN
MS
00019324
1568481141
BLUBAUGH, ROBERT D DO
MERIDIAN
MS
02289823
1548671514
BLUE, MARKETTA MD
JACKSON
MS
00019632
1497783989
BLUMENTHAL, BERNARD MD
JACKSON
MS
00880136
1679672729
BLY, KREGG S OD
VICKSBURG
MS
00125731
1669496915
BLYTHE, CAROLYN A NP
CARRIERE
MS
04283273
1700210432
BLYTHE, RAYMOND P CFNP
VICKSBURG
MS
06670725
1417110982
BOATRIGHT, BENJAMIN T MD
AMORY
MS
00118298
1437230679
BOATWRIGHT, NANCY FNP
HOLLY SPRINGS
MS
30
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00115388
1811969330
BOBO, RICHARD H
TUPELO
MS
07526012
1053419820
BOBO, SUSAN D NP
MERIDIAN
MS
07629213
1689938078
BOCKENSTEDT, PATRICK L MD
JACKSON
MS
07109262
1013977669
BODOR, DANIEL MD
HATTIESBURG
MS
00120739
1033154935
BOFILL, JAMES A MD
JACKSON
MS
00878849
1306167788
BOGI, SANDHYA R MD
TUPELO
MS
09205500
1346552353
BOHNEN, PAUL A MD
ACKERMAN
MS
07224541
1104280239
BOJIKIAN, KARINE D MD
JACKSON
MS
07188733
1437135373
BOLAND, ANTHONY B
JACKSON
MS
00115039
1104867936
BOLAND, MICHAEL J MD
AMORY
MS
01028053
1932376316
BOLDEN, BRANSON B MD
CORINTH
MS
09706794
1215258702
BOLDIZAR, BRADLEY MD
TUPELO
MS
00113949
1790754000
BOLDON, BILLY MD
GREENWOOD
MS
08320276
1578926663
BOLER, HENRY B MD
JACKSON
MS
02186785
1043300585
BOLER, MARGO D OD
OLIVE BRANCH
MS
08653821
1023305687
BOLER, MICHAEL T DO
JACKSON
MS
00013771
1821071267
BOLER, MICHAEL T MD
GREENWOOD
MS
09952743
1730277757
BOLES, NATHAN D MD
GULPORT
MS
00436561
1144660135
BOLES, PEGGY L MD
JACKSON
MS
00015222
1699734855
BOLES, PRESTON DPM
GREENWOOD
MS
09538704
1538189048
BOLEWARE, ANGELA L FNP
JACKSON
MS
00120486
1780615948
BOLING, GREG H MD
FLOWOOD
MS
07029064
1598199291
BOLIVAR, STEPHEN M NP-C
LAUREL
MS
00120764
1194745497
BOLTON, KIRSTEN J MD
SALTILLO
MS
00880352
1891163598
BOLTON, MATTHEW D CNP
HATTIESBURG
MS
00112872
1033123716
BOMBOY, DAVID W MD
HATTIESBURG
MS
07550094
1841452661
BOND, ALLYN H MD
JACKSON
MS
00660396
1114931896
BOND, DENNIS D DDS
TUPELO
MS
31
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125418
1700890498
BOND, LISA MD
LAUREL
MS
00289304
1578734166
BOND, TABITHA S CFNP
VANCLEAVE
MS
08626243
1518392158
BONDI, NOEL D NP
STARKVILLE
MS
05359706
1922067933
BONDI, STEVEN A MD
JACKSON
MS
09829211
1700125895
BONNER, BREANNA L CFNP
ELLISVILLE
MS
00114973
1497788178
BONNER, DONALD R MD
JACKSON
MS
02283809
1114096856
BONNER, GAREY A
WAYNESBORO
MS
09477566
1336293604
BONVILLAIN, FRANK MD
JACKSON
MS
06685060
1730340563
BOOKER, KAYTI A CPNP
PHILADELPHIA
MS
00012582
1720087521
BOOKER, WILLLIAM L MD
CLARKSDALE
MS
01786739
1558559823
BOOKERT, RITHA G FNP
BRANDON
MS
03683291
1881034254
BOOKHARDT, MICHAEL MD
JACKSON
MS
02956343
1619926433
BOONE, DANIEL MD
MCCOMB
MS
04805897
1568801108
BOONE, GABRIELLE E C-NP
MERIDIAN
MS
06224385
1770925398
BOONE, JOSEPH D DMD
FLOWOOD
MS
08832041
1144762568
BOONE, KAREN L CFNP
CANTON
MS
06879707
1750797874
BOONE, SHELLY R NP
FOREST
MS
08304376
1013396837
BOONE, TIFFANY L FNP
HATTIESBURG ST
MS
08131549
1972784999
BOONE, WILLIAM W MD
BAY SPRINGS
MS
03231814
1417351883
BOOSE, JENNIFER A WHNP-
FLOWOOD
MS
05903095
1275860256
BOOTH, ASHLIE N MD
JACKSON
MS
00113548
1093788523
BOOTH, DAVID G DO
EUPORA
MS
06670791
1023307840
BOOTH, KIMBERLY D NPC
FLOWOOD
MS
05303750
1447286539
BOOTH, PATRICK K MD
OXFORD
MS
00018114
1356355655
BOOTHE, JAMES C MD
MCCOMB
MS
07581768
1194776286
BORCHELT, MARK MD
GULFPORT
MS
09174000
1730229816
BORDEN, AMBER M MD
COLUMBUS
MS
08375739
1710026034
BORDEN, ROBERT C MD
COLUMBUS
MS
32
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02604800
1891750923
BORDERS-BLACKWELL, ANNIE T DO
MOUND BAYOU
MS
02752313
1902916778
BORG, BRIAN B MD
JACKSON
MS
09933313
1235139866
BORGANELLI, SANTO M MD
HATTIESBURG
MS
00114935
1588750178
BORNE, MICHAEL J MD
JACKSON
MS
06924393
1215950373
BOROWICZ, MICHAEL J DO
KOSCIUSKO
MS
00015972
1417042979
BORUM, CHARLES D MD
NATCHEZ
MS
04239837
1760465058
BOSARGE, JOSEPH R MD
GULFPORT
MS
00115296
1942276878
BOSCO, JR, JULIUS DO
PASCAGOULA
MS
06073364
1417989138
BOSKOVICH, STEPHEN M MD
GULFPORT
MS
09223874
1184937690
BOSTICK, JOSHUA E
SALTILLO
MS
09528347
1043249295
BOSTON, CHANDRA A
WHITFIELD
MS
07354006
1295932390
BOSTON, CHRISTOPHER D MD
JACKSON
MS
09089710
1316991219
BOSWELL, JOHN C MD
COLUMBUS
MS
04209575
1356403570
BOTELER, WILLIAM L
JACKSON
MS
00120467
1164467643
BOULDIN, SHEILA D M.D.
JACKSON
MS
00660241
1720142219
BOUNDS, JAMES A DMD
LAUREL
MS
02138051
1841739695
BOURGEOIS, ASHLEY M NP
BILOXI
MS
09628768
1487089546
BOURNES, DORETHA B
JACKSON
MS
09584761
1184958969
BOUTWELL, JENNIFER B FNP
MCCOMB
MS
03805541
1114218633
BOVADOU, JEFFERY L MD
BILOXI
MS
00112065
1558380477
BOWDEN, DOUGLAS E DO
GREENWOOD
MS
02831318
1376725176
BOWE, REGINA N MD
MCCOMB
MS
02277207
1619919156
BOWEN IV, LENNON E MD
GULFPORT
MS
05035006
1720344583
BOWEN, CHRISTOPHER E MD
BILOXI
MS
08335795
1306182035
BOWEN, JASON R NP
HARRISVILLE
MS
02852032
1851768089
BOWEN, SARAH NP
HATTIESBURG
MS
08623374
1689067324
BOWENS, KIMAKA J FNP-C
PICAYUNE
MS
02902743
1023420627
BOWES, CHRISTA D MD
JACKSON
MS
33
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04434031
1972506020
BOWIE, HOLLY E OD
PASCAGOULA
MS
02384896
1902805120
BOWLES, WILLIAM E DO
BRANDON
MS
08602887
1174604318
BOWLIN, BRADLEY MD
MEADVILLE
MS
01182331
1982803862
BOWLING, WILLIAM B MD
HATTIESBURG
MS
07026504
1174892822
BOWMAN, CLAUDIA L CFNP
SEBASTOPOL
MS
00123850
1679566822
BOX, ANITA
TUPELO
MS
00027266
1851448906
BOX, JASON S CFNP
LUCEDALE
MS
02087008
1396973863
BOX, SAMUEL K DO
RIPLEY
MS
04179201
1225341100
BOYD, ANGELA (LYNN) B FNP
MERIDIAN
MS
05309779
1134510100
BOYD, ANGELA D NP
RIDGELAND
MS
00110447
1386715514
BOYD, BRUCE K DPM
CORINTH
MS
00660208
1881804532
BOYD, CHRIS G DMD
MONTICELLO
MS
02887716
1679598783
BOYD, COLEMAN A MD
CLINTON
MS
06520767
1922033927
BOYD, DANIEL L MD
OXFORD
MS
09572201
1588790497
BOYD, DONNA M FNP
D'IBERVILLE
MS
02721245
1669745659
BOYD, HOLLY E NP
LONG BEACH
MS
00010099
1417057381
BOYD, JEFFERY J MD
BROOKHAVEN
MS
00121690
1730155946
BOYD, JOHN T MD
MERIDIAN
MS
00123853
1306806070
BOYD, ROLAND L DO
MERIDIAN
MS
03301545
1578920328
BOYD, SHANIKA NP
SHUBUTA
MS
05676764
1194954578
BOYD, STEWART A MD
FLOWOOD
MS
04957738
1386097921
BOYD, WESLEY A PA-C
SOUTHAVEN
MS
06082706
1356493951
BOYETTE, KRISTA L MD
PHILADELPHIA
MS
08227811
1376572008
BOYETTE, SCOTT T MD
HATTIESBURG
MS
06457826
1144405390
BOYKIN, CARL A DMD
HAZLEHURST
MS
07223246
1396787180
BOYLES, JON M
PHILADELPHIA
MS
07157261
1972605657
BOYLES, TINA FNP
PHILADELPHIA
MS
08236376
1750756367
BOYTE, MARY C FNP-C
MCCOMB
MS
34
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00113727
1285676908
BOYTE, WILLIAM R MD
JACKSON
MS
05954541
1407398845
BRACEY, BRITTNEY E CNP
COLUMBIA
MS
01781048
1558812263
BRACEY, NASHAMBA A NP
CANTON
MS
00118406
1417969031
BRACKEN, WILLIAM M DO
BATESVILLE
MS
08228765
1831119940
BRADDY, JARAD J DDS
SOUTHAVEN
MS
07423846
1144528381
BRADDY, KRYSTAL DDS
GULFPORT
MS
00121920
1689697336
BRADEN, DAVID S
JACKSON
MS
04854379
1003960907
BRADFORD, CONSTANCE FNP-C
MCCOMB
MS
00060003
1013067362
BRADFORD, CRAIG A DMD
NATCHEZ
MS
06621852
1700954765
BRADFORD, SHEILA D FNP
ELLISVILLE
MS
09822395
1568766145
BRADHAM, LISA S NP
RULEVILLE
MS
03954875
1407043987
BRADLEY, CHAUNTAY Y MD
SOUTHAVEN
MS
00015203
1457466690
BRADLEY, JUDITH L MD
LAUREL
MS
01006292
1922435130
BRADLEY, MARLENA M CNP
HATTIESBURG
MS
03735301
1154577088
BRADLEY, PAUL W DO
MERIDIAN
MS
00113517
1326041591
BRADLEY, SCOTT T MD
COLUMBUS
MS
00123284
1073661344
BRADSHAW, JOYCE MD
GREENWOOD
MS
04036034
1912299496
BRADY, SHARON M FNP
MERIDIAN
MS
01684794
1629371653
BRAGG, ELIZABETH P CFNP
WHITFIELD
MS
04126868
1104037167
BRAHAM, KAREN P MD
JACKSON
MS
00016196
1871507566
BRAHAN, JOHN W MD
HATTIESBURG
MS
00017068
1881608586
BRAHAN, ROBERT B MD
HATTIESBURG
MS
05556291
1154613313
BRAKE, SHELLEY M PA
PASCAGOULA
MS
00121759
1659336196
BRAME, SUSAN FNP
OLIVE BRANCH
MS
05025093
1689678674
BRAND, JACK W MD
BILOXI
MS
00111887
1053492645
BRAND, WOODROW W MD
AMORY
MS
02858556
1114385721
BRANDLE, LAURA A NP
PASCAGOULA
MS
03480066
1639550783
BRANDON, EMILY L
TUPELO
MS
35
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02876535
1124348701
BRANDON, JULIA
CALHOUN CITY
MS
00115386
1225017239
BRANDON, STEVEN C MD
STARKVILLE
MS
00114356
1568533198
BRANNAN, DONALD P MD
FLOWOOD
MS
01331515
1740331743
BRANNAN, PATRICK S MD
GULFPORT
MS
00114322
1679503023
BRANTLEY JR, SHELBY K MD
FLOWOOD
MS
00064651
1447469622
BRANTLEY, JAMES W DMD
JACKSON
MS
00125825
1720181530
BRANTLEY, KARA L MD
JACKSON
MS
00014917
1053355040
BRANTLEY, TERRY MD
JACKSON
MS
06606392
1760756423
BRASHEAR, CATHERINE M FNP
GULFPORT
MS
01583745
1760682090
BRASHIER, MATTHEW S DO
BILOXI
MS
00660174
1154422590
BRASWELL, DAVID R DMD
GRENADA
MS
00112536
1356307946
BRASWELL, THOMAS K MD
GRENADA
MS
00123697
1952330417
BRATTON, CLAYTON R MD
BILOXI
MS
00124071
1225040199
BRAUN, JOHN C
MERIDIAN
MS
00111812
1053302125
BRAWNER, WILLIAM C MD
TUPELO
MS
05539595
1336471515
BRAY, CARLA H
CORINTH
MS
00118418
1255338984
BRAY, GINA DO
NATCHEZ
MS
02309788
1649370503
BRECHTEL, JENNIFER PMHNP
GULFPORT
MS
00116360
1700848207
BREDEMEIER, GREGORY F MD
GRENADA
MS
00111280
1487755641
BREELAND, DONNA G MD
JACKSON
MS
00337566
1538454855
BRELAND, MARK F DMD
ACKERMAN
MS
00771257
1629177688
BRELAND, TOBI L NP
JACKSON
MS
05723715
1932296589
BRENDA P HINES MD
FLOWOOD
MS
00113775
1063513141
BRENT, CHARLES R MD
HATTIESBURG
MS
08234791
1992958169
BRENT, LORI B CFNP
JACKSON
MS
03557861
1790049120
BRENTS, MELISSA J MD
JACKSON
MS
05703817
1649445115
BRETEY, TAMMY M NP
JACKSON
MS
05878266
1346492048
BRETT, CATHERINE E MD
MOUND BAYOU
MS
36
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09226861
1073886446
BREVIL, NOHEMIE MD
CLEVELAND
MS
00120999
1831106418
BREWER JR, EDWARD A MD
WHITFIELD
MS
08326741
1154733392
BREWER, JAMIE L NP
JACKSON
MS
08731739
1619342417
BREWER, JASON K
MERIDIAN
MS
02380874
1811251283
BREWER, JOSEPH M DO
JACKSON
MS
00680383
1366628059
BREWER, JUSTIN M MD
TUPELO
MS
08301549
1720497951
BREWER, KATHLEEN B FNP-C
JACKSON
MS
08358798
1295742823
BREWER, LESLIE F DMD
MCCOMB
MS
00114606
1134160518
BREWER, LINDA
PELAHALCHIE
MS
02187540
1194073528
BREWER, LINDSEY A OD
PICAYUNE
MS
06827817
1588004907
BREWER, SARA E DO
JACKSON
MS
02222522
1073727129
BRICE, CARNEY A DDS
BILOXI
MS
01270868
1164834206
BRICE, JORDAN A MD
JACKSON
MS
03009581
1154339414
BRIDGERS III, DAVID I MD
OXFORD
MS
05237761
1013464494
BRIDGES, AMY CFNP
RIPLEY
MS
04375734
1306862123
BRIDGES, BAYLISSA M PA-C
PASCAGOULA
MS
00114535
1043210024
BRIDGES, ERIC W
MERIDIAN
MS
04873326
1780988949
BRIDGES, HOLLY M CFNP
JACKSON
MS
06407535
1205065554
BRIDGES, JAMES K MD
MADISON
MS
03239815
1003129651
BRIDGES, JASON P MD
JACKSON
MS
03225769
1790170520
BRIDGES, JOHN M MD
JACKSON
MS
02650399
1619317963
BRIDGES, KIMBERLY D MD
JACKSON
MS
01952301
1114170529
BRIDGES, RORI E FNP
FOREST
MS
00116459
1831176973
BRIDGEWATER, JOVIE N MD
SOUTHAVEN
MS
06508393
1760627996
BRIEN, G ANTHONY MD
FLOWOOD
MS
03771729
1275645889
BRIGHT, SANDRA L OD
BATESVILLE
MS
06007354
1609884329
BRIHMADESAM, LATHA J MD
STARKVILLE
MS
06328019
1548357593
BRIMHALL, BRADLEY B MD
JACKSON
MS
37
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05501029
1760412688
BRIN, EDWARD N MD
CANTON
MS
00660332
1720154180
BRISTER JR, GERALD D DDS
PEARL
MS
03257226
1568473270
BRISTER, JACKIE E FNP
MCCOMB
MS
05924862
1811381957
BRISTER, KELLY A MD
JACKSON
MS
00124847
1427083625
BRISTER, STEVEN L
TUPELO
MS
02939763
1720022122
BRISTOL, GERALD A MD
BILOXI
MS
06420719
1255593265
BRITT, BLAINE C MD
BROOKHAVEN
MS
01156782
1346260197
BRITT, JEFFREY T NP
COLUMBUS
MS
00880224
1992822985
BRITT, LLOYD P OD
TUPELO
MS
00124690
1376557462
BRITT, ROBERT
BROOKHAVEN
MS
05287077
1003842378
BRITTON, MARCUS L MD
TUPELO
MS
02402792
1104137942
BRITTON, MARY
MERIDIAN
MS
00115076
1689761280
BROCK JR, CHARLES F MD
CLEVELAND
MS
01570890
1871640292
BROCK, DOREEN CFNP
BILOXI
MS
03679540
1073742607
BROCK, JAMES B MD
JACKSON
MS
06971344
1912036823
BROCK, JAMES M JR
MCCOMB
MS
00737224
1720053952
BROCK, JULIE C OD
SALTILLO
MS
08970301
1598765943
BRODELL, ROBERT T MD
JACKSON
MS
00122484
1164480109
BROHAWN, WILLIAM E M.D.
AMORY
MS
00012689
1720094196
BROOKINS REDDIX, NATALIE MD
JACKSON
MS
00115755
1225190689
BROOKS, ANNE E
TUTWILER
MS
09629062
1306243936
BROOKS, DANA W NP
STARKVILLE
MS
00115614
1962440214
BROOKS, DAVID J MD
TUPELO
MS
00087860
1972590859
BROOKS, JAMES E OD
COLUMBUS
MS
00117257
1023046711
BROOKS, JOHN C MD
JACKSON
MS
05281873
1316491012
BROOKS, LAURA JEAN S FNP-C
MCCOMB
MS
00015226
1104836543
BROOKS, MICHAEL P MD
ELLISVILLE
MS
00631556
1407120280
BROOKS, SCHERUN M FNP
CORINTH
MS
38
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00116521
1477589356
BROOKS, TAMI H MD
JACKSON
MS
07734393
1063588788
BROOM, REGGIE H DMD
GULFPORT
MS
00119222
1720007040
BROOME, CHARLENE B MD
HATTIESBURG
MS
00115157
1386601227
BROOME, DAVID V MD
HATTIESBURG
MS
05486344
1013930296
BROPHY, JOHN
SOUTHAVEN
MS
05859035
1518404235
BROSH, TIFFANY NP
GULFPORT
MS
00113380
1447248661
BROUSSARD, CURTIS A MD
GULFPORT
MS
09077770
1942272513
BROUSSARD, ISAAC D MD
MCCOMB
MS
00659703
1508229618
BROUSSE, BRANDON R MD
JACKSON
MS
00126317
1336231489
BROWN III, JAMES S MD
STARKVILLE
MS
01506043
1326489345
BROWN III, EDWARD V DDS
GULFPORT
MS
02604753
1598212623
BROWN JR, EDWARD V DDS
GULFPORT
MS
00014592
1073578043
BROWN JR, JULIAN A MD
ABERDEEN
MS
08421077
1669640850
BROWN, ALEXANDRA S MD
FLOWOOD
MS
03139351
1568825677
BROWN, ANDREW MD
JACKSON
MS
00125006
1710913801
BROWN, BEVERLY MD
JACKSON
MS
05106261
1861672990
BROWN, BILLY J PA-C
CLARKSDALE
MS
00116148
1992736870
BROWN, BRADLEY P MD
COLUMBUS
MS
07980793
1508294505
BROWN, BRENDA L FNP
NATCHEZ
MS
00116150
1841221702
BROWN, BRETT O MD
COLUMBUS
MS
00576837
1841259413
BROWN, BRUCE W MD
MERIDIAN
MS
08587279
1013227743
BROWN, CARLA K FNP
LIBERTY
MS
00119010
1699880534
BROWN, CHARLES E MD
SOUTHAVEN
MS
07231367
1487944617
BROWN, COREY N DO
RULEVILLE
MS
06726261
1184906075
BROWN, DEMESIA D FNP
CANTON
MS
07309251
1083813240
BROWN, DIXIE G CFNP
FLOWOOD
MS
00227749
1659734135
BROWN, ELAINE H MD
JACKSON
MS
05973564
1336422021
BROWN, ELIZABETH W NP
BROOKHAVEN
MS
39
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00112107
1356498422
BROWN, FELICIA M
JACKSON
MS
00120988
1841200771
BROWN, FRANK A M.D.
YAZOO CITY
MS
02836871
1043691603
BROWN, HAMILTON M DMD
CLEVELAND
MS
05722721
1356537088
BROWN, JACOB A MD
STARKVILLE
MS
00880002
1447364005
BROWN, JAMES E OD
BRUCE
MS
03358253
1528096971
BROWN, JAMES J MD
JACKSON
MS
00087780
1508938812
BROWN, JAMES R OD
RIPLEY
MS
06773829
1043672132
BROWN, JAMES T MD
JACKSON
MS
05580006
1083843551
BROWN, JASON R DMD
YAZOO CITY
MS
05222261
1346390093
BROWN, JEFF T DO
TUPELO
MS
05789090
1851373625
BROWN, JEFFREY S DMD
MADISON
MS
05224371
1154377950
BROWN, JILL M MD
NEW ALBANY
MS
08107759
1023362456
BROWN, KATHRYN L MD
JACKSON
MS
05800329
1518380120
BROWN, KEILA L NP
JACKSON
MS
00660013
1225258676
BROWN, KEITH A DMD
LUCEDALE
MS
08335366
1376710756
BROWN, KEITH A MD
FLOWOOD
MS
07276057
1841584711
BROWN, KIMBERLY L MD
OCEAN SPRINGS
MS
05051851
1811439490
BROWN, LUAN L NP
OCEAN SPRINGS
MS
07900358
1033464508
BROWN, MOLLY B CFNP
GRENADA
MS
00014000
1184727745
BROWN, NATE M.D.
MOUND BAYOU
MS
00015087
1912990961
BROWN, RAYMOND L MD
NATCHEZ
MS
06837070
1215391354
BROWN, RODERICK S DO
JACKSON
MS
00122364
1104860907
BROWN, RONNIE K NP
JACKSON
MS
05087743
1245619642
BROWN, RYAN W MD
JACKSON
MS
02224073
1104810605
BROWN, SAMUEL MD
JACKSON
MS
06836323
1568855179
BROWN, SCHYLER D FNP
JACKSON
MS
08255879
1790003044
BROWN, SHARI R FNP
RIDGELAND
MS
00124512
1770674467
BROWN, SHARON K NP
JACKSON
MS
40
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04885554
1285760843
BROWN, STEPHEN J DO
JACKSON
MS
00126120
1437192911
BROWN, THOMAS L MD
PASCAGOULA
MS
02435011
1225472483
BROWN, VALERIE NP
COLUMBUS
MS
02676315
1083071237
BROWN, WANDA L WHNP
HOLLY SPRINGS
MS
09507866
1396185765
BROWNING, JOHN MD
TUPELO
MS
09656576
1073585824
BROWNING, ROBERT G MD
KOSCIUKO
MS
09734374
1215035985
BROWNLEE, ROBIN G FNP
LEAKESVILLE
MS
01259224
1548655400
BROWNLEE, ROSALYN E MD
JACKSON
MS
08131791
1780773762
BROWNSTEIN, RICHARD E MD
CLARKSDALE
MS
04735071
1407854037
BRUBAKER, ROCKNE L MD
GREENWOOD
MS
00015790
1114020906
BRUCE JR, JAMES A MD
JACKSON
MS
00124844
1295739894
BRUCE, ANDREA M
COLLINS
MS
08206565
1073996765
BRUCE, ANNA C DMD
BROOKHAVEN
MS
09931583
1740646421
BRUCE, CHARLES A CNP
SUMRALL
MS
07089078
1720275753
BRUCE, JULIA S CFNP
FLOWOOD
MS
00725822
1942267281
BRUCE, KAREN H MD
COLLINS
MS
08076871
1073975157
BRUCH III, WILLIAM M MD
JACKSON
MS
00016251
1083610117
BRUCKMEIER, KURT F MD
HATTIESBURG
MS
01454202
1013103613
BRUMFIELD, EMILY K ACNP
JACKSON
MS
02902324
1861801888
BRUMFIELD, SHERMANDA M FNP
HATTIESBURG
MS
08505293
1780629147
BRUMMITT, KENYETTA D MD
BATESVILLE
MS
00116587
1235245994
BRUNER, BILLIE W MD
FLOWOOD
MS
09922235
1972802130
BRUNET, BARBARA A MD
JACKSON
MS
00014208
1093819435
BRUNI, RONALD T MD
GULFPORT
MS
00120712
1871604611
BRUNI, TIMOTHY G MD
GULFPORT
MS
07150851
1861421406
BRUNO, JONATHAN J MD
CARTHAGE
MS
05556731
1790928687
BRUNSON, ALLISON B FNP
NEWTON
MS
00016574
1073614194
BRUNSON, CLAUDE D MD
JACKSON
MS
41
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06636853
1265420467
BRUNSTON JR, ROBERT L MD
BILOXI
MS
00117494
1689672156
BRUNT, JOEL R MD
PASCAGOULA
MS
03780785
1386029767
BRUNT, VALERIE W NP
JACKSON
MS
09122794
1790899912
BRYAN, BRAD Y DMD
TUPELO
MS
05534816
1609815190
BRYAN, JENNIFER A MD
BILOXI
MS
02583806
1417976739
BRYAN, JENNIFER J MD
JACKSON
MS
03450522
1699149708
BRYAN, MELISSA A CNM
MERIDIAN
MS
00123962
1558378869
BRYANT, BEVERLY J MD
JACKSON
MS
08375326
1124305479
BRYANT, BRITTANY FNP
CORINTH
MS
05851817
1194745315
BRYANT, MICHELE R NP
PRENTISS
MS
00858344
1669539391
BRYANT, SUZANNE FNP
MCCOMB
MS
08133377
1740675487
BRYSON, ALAN PA-C
LAUREL
MS
08102202
1811009145
BUCHANAN, JOHN P
JACKSON
MS
04438323
1073925244
BUCHANAN, JONATHAN MD
WALNUT GROVE
MS
04958871
1417971029
BUCHANAN, SHANTWANIA A MD
CORINTH
MS
00660410
1285791210
BUCHANAN, WILLIAM DDS
JACKSON
MS
01904364
1639565013
BUCK, LAUREN D MD
JACKSON
MS
08921288
1902292527
BUCK, MATTHEW P MD
JACKSON
MS
07431002
1003027764
BUCK, TONDRE T MD
JACKSON
MS
00124865
1972616332
BUCKELS, CAROL A CFNP
BROOKHAVEN
MS
03630279
1396922423
BUCKHEISTER, NANCY A ACNP
OCEAN SPRINGS
MS
09002340
1346477718
BUCKIUS, MICHELLE T MD
JACKSON
MS
04230014
1528053212
BUCKLES, ANTHONY L MD
NATCHEZ
MS
08002873
1518178839
BUCKLEY, BRANDIE D CFNP
CHOCTAW
MS
03274801
1972840585
BUCKLEY, CHRISTEN H NP
JACKSON
MS
00110707
1093786980
BUCKLEY, ROBERT C MD
TUPELO
MS
00112393
1356314702
BUCKLEY, ROBERT L MD
COLUMBUS
MS
01005055
1730550849
BUCKLEY, RYAN E NP
GULFPORT
MS
42
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00011825
1740283126
BUCKLEY, STEPHEN E
HATTIESBURG
MS
00119669
1003836669
BUCKNER, IRENE S MD
CLARKSDALE
MS
09583708
1841361714
BUCKNER, SHAREEN
NEWTON
MS
01835344
1821447657
BUCKNER, TENNISHA N DMD
TUPELO
MS
07725286
1922146760
BUECHLER, KURT A MD
RIDGELAND
MS
01722884
1568407625
BUEHLER, MICHAEL A MD
COLUMBUS
MS
01282702
1598916256
BUENAFE, XANDER H MD
GREENVILLE
MS
01253543
1437541109
BUFFINGTON, LAUREN W NP-C
JACKSON
MS
00116461
1053315507
BUFFINGTON, LINDA B
COLLINS
MS
08981031
1942404496
BUFKIN, PATRICK J MD
JACKSON
MS
02228017
1972706042
BUFORD, JUSTIN MD
NATCHEZ
MS
06351722
1699152249
BUI, BRIAN H DO
JACKSON
MS
03153577
1093194268
BUI, ELIZABETH MD
JACKSON
MS
00227093
1730443201
BUICE, ASHLEY L MD
JACKSON
MS
00081861
1639352123
BUIE, JOYCE D FNP
CLARKSDALE
MS
00019928
1760496244
BULLARD, RICKEY H DPM
TUPELO
MS
04304781
1457541450
BULLIN, CHRISTOPHER J OD
JACKSON
MS
00737837
1043268709
BULLOCK JR, JOHNNY R MD
FOXWORTH
MS
00121120
1942217757
BULLOCK, JOHN D MD
SUMRALL
MS
09050222
1750774634
BULLOCK, JOHN R MD
JACKSON
MS
07330540
1679862817
BULLOCK, PATRICIA A NP-C
LAUREL
MS
00019948
1437166832
BULLOCK, RONALD A MD
HATTIESBURG
MS
03856719
1689807612
BULLOCK, WENDELL B PA
HATTIESBURG
MS
07435051
1114318417
BUNTIN, JEFFERSON R NP
PICAYUNE
MS
02136002
1164794178
BUNYARD, HEATHER D FNP
MERIDIAN
MS
05178241
1699723957
BURAS, JON A MD
HATTIESBURG
MS
06151228
1679509061
BURCH, MURRAY
JACKSON
MS
06072709
1447426192
BURCH, PHYLLIS J NP
COLUMBIA
MS
43
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00060237
1801837265
BURCH, SANDRA DMD
JACKSON
MS
07077714
1609967520
BURCHAM, PENNY FNP
CORINTH
MS
00114578
1346260486
BURES, MARY E CFNP
JACKSON
MS
04327819
1184879439
BURGE, GINA NP
JACKSON
MS
05006565
1669673679
BURGE, MARY B MD
COLUMBUS
MS
08454009
1508143546
BURGER, EMILY A PA
GULFPORT
MS
00116449
1437193984
BURGER, ERIC MD
BRANDON
MS
08934004
1720244932
BURGESS, DERRICK L MD
LAUREL
MS
06420526
1467751917
BURGESS, GRETA M NP
AMORY
MS
05658863
1356599237
BURGESS, MYEASHA K DDS
HATTIESBURG
MS
00123008
1518991033
BURK, JOHN D MD
TUPELO
MS
03686772
1225495476
BURKES, KRISTEN B ACNP
JACKSON
MS
05753337
1538322052
BURKETT, BENJAMIN R MD
PETAL
MS
00015186
1962515619
BURKHALTER, JAMES
RIDGELAND
MS
09402277
1861620148
BURKS, CHRISTOPHER A MD
VANCLEAVE
MS
00115603
1255348645
BURKS, SCOTT G
HATTIESBURG
MS
02007574
1922060722
BURLESON, WILLIAM D MD
PASCAGOULA
MS
02350031
1003137399
BURMAN, KABEER MD
HATTIESBURG
MS
00121088
1639182124
BURN, DEEPINDER P MD
WIGGINS
MS
00121745
1700885217
BURNETT, MARY
BATESVILLE
MS
00257732
1396286209
BURNETT, TONI NP
TUPELO
MS
00114468
1093801227
BURNETT, WALTER M MD
YAZOO CITY
MS
02904035
1134502792
BURNEY, STEVIE H NP
JACKSON
MS
04536289
1427312800
BURNHAM, JORDAN M MD
JACKSON
MS
09735576
1396292033
BURNS, AMANDA D PMHNP
FLOWOOD
MS
00457592
1730459504
BURNS, ANNA M PA-C
OXFORD
MS
00127780
1467550673
BURNS, BRADLEY A MD
MERIDIAN
MS
05526566
1053608224
BURNS, CASSIE K MD
JACKSON
MS
44
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07679050
1346642428
BURNS, COURTNEY CFNP
LUCEDALE
MS
00175800
1033115597
BURNS, JEFFREY A MD
HATTIESBURG
MS
00928792
1568759090
BURNS, JOHN F MD
JACKSON
MS
01426024
1720179401
BURNS, ROBERT B MD
PASCAGOULA
MS
06274315
1518229970
BURNS, SARA J NP
JACKSON
MS
05203067
1053695668
BURNSED, BRYNNA PA
PASCAGOULA
MS
07780042
1962737551
BURR, BRANDI C NP
JACKSON
MS
09172334
1083804322
BURRAGE, KIMBERLY A OD
LAUREL
MS
00117760
1013023944
BURRIS, REBECCA H CFNP
MONTICELLO
MS
00015262
1487652228
BURRIS, RICHARD G M.D.
MONTICELLO
MS
01334012
1518235142
BURROUGHS LOVETT, ASHLEY N NP
BILOXI
MS
04571219
1760674949
BURROUGHS, RALPH L NP
GULFPORT
MS
03786756
1750395489
BURROW III, WILLIAM H
FLOWOOD
MS
03528721
1508046236
BURROW, JAMEY W MD
JACKSON
MS
00979363
1992890222
BURT, ANGELA M MD
BILOXI
MS
00063225
1396809034
BURTON, CHARLES H DDS
GREENVILLE
MS
00015954
1801895164
BURWELL JR, DUDLEY S M.D.
BILOXI
MS
00110020
1427012657
BURWELL, JOEL B D.O.
GULFPORT
MS
04930854
1063840148
BURWELL, SARA N FNP-C
JACKSON
MS
00110314
1871646323
BUSCH, LANCE E DO
COLUMBUS
MS
00019433
1932243946
BUSH JR, CHARLES C
FLOWOOD
MS
00111279
1417058785
BUSH, FREDA M MD
JACKSON
MS
00121967
1043334568
BUSH, NADINE K
MENDENHALL
MS
06523862
1992908065
BUSH, RICHARD MD
VICKSBURG
MS
03023898
1912215344
BUSH, STEVEN M AT
JACKSON
MS
00121297
1023115565
BUSH, WILLIAM G M.D.
JACKSON
MS
00012749
1669488979
BUSHARDT, LISA MD
HATTIESBURG
MS
05886531
1275627747
BUSSA, GWENDOLYN
JACKSON
MS
45
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00124691
1982683173
BUTLER, ABIDA B MD
PICAYUNE
MS
07876703
1164741153
BUTLER, CHARLES F MD
JACKSON
MS
00010931
1750312963
BUTLER, GLORIA MD
VICKSBURG
MS
00018455
1669464012
BUTLER, HARRY L MD
HATTIESBURG
MS
00018912
1326081985
BUTLER, JOEL A
COLUMBUS
MS
03539291
1437561982
BUTLER, LAKESHA J ANP
TUPELO
MS
08836830
1265445472
BUTLER, REBECCA H FNP
BELDEN
MS
08259096
1194752246
BUTLER, ROBERT A MD
STARKVILLE
MS
07506566
1164688891
BUTLER, STEPHANIE FNP
CANTON
MS
08858701
1447690805
BUTT, ASMA MD
JACKSON
MS
08736507
1538398540
BUTT, SAIRA MD
JACKSON
MS
04973838
1528327517
BUTT, SHERA A NP
GULFPORT
MS
00016330
1750316691
BUTTROSS, SUSAN MD
JACKSON
MS
00122917
1609926161
BUTTS, DALLAS W MD
TUPELO
MS
01736503
1164731931
BUTTS, LATIA M NP-C
FLOWOOD
MS
09587011
1780948505
BUTTS, MEGAN N NP
JACKSON
MS
07458896
1770711566
BUTTS, PAUL E MD
BILOXI
MS
00125938
1518903178
BYARS, RICHARD W MD
OXFORD
MS
00015597
1609926211
BYDALEK, MARTIN B
PASCAGOULA
MS
01404350
1770824476
BYERS, ALYSIA M FNP
FLOWOOD
MS
00116198
1346311982
BYERS, MICHAEL R MD
JACKSON
MS
00120556
1821123670
BYERS, PAUL E MD
JACKSON
MS
08670068
1306101050
BYNUM, ANDREA T ACNP
OXFORD
MS
04777596
1558651919
BYNUM, JOSEPH A MD
NEW ALBANY
MS
09422705
1467778423
BYNUM, LEANNE T FNP
BAY SPRINGS
MS
04673022
1174980213
BYNUM, MARSHALL J PA-C
HATTIESBURG
MS
00122589
1437179967
BYNUM, PATRICK S MD
PASCAGOULA
MS
02477395
1609041532
BYNUM, STEPHANIE D MD
SUMRALL
MS
46
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00120729
1447237482
BYRAM, MELODY F DO
MERIDIAN
MS
06383271
1689969735
BYRD, ADAM C MD
JACKSON
MS
00502556
1477992121
BYRD, ADAM D DMD
FLORENCE
MS
04675575
1710390943
BYRD, JENNIFER A NP
HATTIESBURG
MS
02601045
1386701464
BYRD, JOYCE M DDS
FLOWOOD
MS
06678813
1407109945
BYRD, LEA A FNP
CLARKSDALE
MS
08926059
1902977846
BYRD, LINDA T GNP
GULFPORT
MS
00117435
1407845829
BYRD, LISA CFNP
MADISON
MS
00016364
1821070236
BYRD, OLIVER W
QUITMAN
MS
00660274
1548323579
BYRD, THOMAS R DMD
FLORENCE
MS
05783804
1225227663
BYRD, WILLIAM E MD
MERIDIAN
MS
05450294
1629164611
BYRNE, THOMAS F MD
TUPELO
MS
09806261
1346263753
BYRNES, ED J DO
TUPELO
MS
09226525
1407850019
CABE, ANNABELLE D MD
BYHALIA
MS
09981868
1174829733
CABE, KIMBERLY NP
LAUREL
MS
06105355
1043214653
CABE, LORENZO C MD
HERNANDO
MS
01207059
1184855207
CABEZA RIVERA, FRANCO C MD
JACKSON
MS
05009004
1477560878
CABRAL, LAURIE CFNP
BILOXI
MS
08151212
1467683706
CABRAL, MARIA D MD
JACKSON
MS
05300861
1396290607
CACIOPPO, JENNIFER J NP
PICAYUNE
MS
06736355
1952690224
CADDELL, KIRK A MD
AMORY
MS
00122754
1144358490
CADDEN, DOLLIE J NP
BATESVILLE
MS
00125341
1699718197
CADE, JAMES M MD
WIGGINS
MS
00115732
1407838154
CADY, JR., JAMES D
MERIDIAN
MS
06678309
1356340657
CAFFREY, JAMES A DO
PICAYUNE
MS
00727364
1700226123
CAGER, NIKKI N MD
CLARKSDALE
MS
00834230
1558410035
CAGLE, LAURIE W OD
FULTON
MS
04178581
1891941241
CAGLE, MISTY W NP
PETAL
MS
47
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01703544
1821044454
CAHILL, BRIDGET R FNP
ELLISVILLE
MS
06455702
1518378538
CAILLET, AIMEE R MD
JACKSON
MS
00010791
1790709079
CAIN JR, GEORGE L MD
CORINTH
MS
00660209
1780739656
CAIN, JOSEPH J DMD
WIGGINS
MS
00123546
1306869102
CAIN, KENNETH B M.D.
LAUREL
MS
00503019
1245462282
CAIN, RALPH T NP
TUPELO
MS
00114934
1770595753
CAIN, ROBERT J
STARKVILLE
MS
07354050
1346284130
CALABRESE, PATRICIA
HATTIESBURG
MS
04158796
1316933138
CALANDRUCCIO, JAMES H MD
SOUTHAVEN
MS
00117192
1073622999
CALCOTE, BRYAN S
BROOKHAVEN
MS
07985373
1811340201
CALCOTE, JOSHUA B
TUPELO
MS
00120072
1770635229
CALCOTE, VICTOR I MD
PASCAGOULA
MS
09577701
1215340286
CALDERONE, RICHARD C DO
WHITFIELD
MS
03473847
1700141074
CALDWELL, JENNIFER M FNP
TUPELO
MS
00118186
1790792414
CALHOUN, LINDA G DPM
OCEAN SPRINGS
MS
08677064
1053753194
CALHOUN, TANYA L FNP-C
RIDGELAND
MS
00117346
1932219177
CALHOUN, WILLIAM B MD
TUPELO
MS
09035211
1164523189
CALIMARAN, ARTHUR L MD
JACKSON
MS
03722719
1396185542
CALL, JANA M NP
PONTOTOC
MS
08585701
1548476252
CALLAGHAN, TIMOTHY J MD
ROBINSONVILLE
MS
03755233
1992839088
CALLAHAN, BRIAN S OD
PEARL
MS
07280201
1093129231
CALLAHAN, KRISTIE U NP
JACKSON
MS
05985349
1669552642
CALLAHAN, SHERRY D FNP
CORINTH
MS
07600350
1740353291
CALLAWAY, COOPER E DMD
STARKVILLE
MS
05871393
1932157500
CALOSS JR, RON DDS
JACKSON
MS
09150891
1932157500
CALOSS JR, RON MD
JACKSON
MS
07385544
1154369726
CALVERT, EDWARD H MD
JACKSON
MS
02126789
1861695264
CALVERT, GRAHAM C MD
JACKSON
MS
48
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03322089
1427031731
CALVIT, THOMAS B
MERIDIAN
MS
02374840
1295130706
CAMACHO GOMEZ, SANDRA M MD
JACKSON
MS
00014076
1740365055
CAMERO, FRANCISCO MD
GULFPORT
MS
00113771
1235159302
CAMPBELL JR, JOE H MD
HATTIESBURG
MS
04801259
1770876377
CAMPBELL, AMY E NP
VICKSBURG
MS
00127100
1801199666
CAMPBELL, AMY R FNP
LAUREL
MS
08608822
1962826925
CAMPBELL, CHERISH E CPNP
OCEAN SPRINGS
MS
06150219
1104078567
CAMPBELL, GARTH S MD
JACKSON
MS
00010478
1063429470
CAMPBELL, GLENN A
HATTIESBURG
MS
06482511
1053331421
CAMPBELL, JAMES K MD
GULFPORT
MS
09502276
1841613676
CAMPBELL, JAMES T MSN
JACKSON
MS
00064035
1861420820
CAMPBELL, LEE G DDS
NATCHEZ
MS
07284015
1861699357
CAMPBELL, LEIGH R MD
JACKSON
MS
05120287
1427435783
CAMPBELL, LIANA R MD
JACKSON
MS
07224026
1043625668
CAMPBELL, LUKE MD
TUPELO
MS
05884740
1720368855
CAMPBELL, MADELENA T NP
GULFPORT
MS
02255074
1225090715
CAMPBELL, MARK E MD
OXFORD
MS
00126050
1598747529
CAMPBELL, MELISSA D MD
MERIDIAN
MS
02489072
1558432005
CAMPBELL, NANCY L MD
JACKSON
MS
09953812
1689920209
CAMPBELL, PATRICIA L NP
MACON
MS
03455575
1689066151
CAMPBELL, ROBIN E CNP
HATTIESBURG
MS
05521313
1871799684
CAMPBELL, WILLIAM F MD
RIDGELAND
MS
01226767
1265630842
CAMPROGERS, TERESA MD
LAUREL
MS
01380410
1013115088
CANIZARO, ASHLEY M MD
JACKSON
MS
00014391
1841214145
CANNON JR, CHARLES D
LAUREL
MS
08553384
1437269479
CANNON, CHARLES R MD
FLOWOOD
MS
08153779
1518994672
CANNON, COLLEEN G
JACKSON
MS
00011216
1033103122
CANNON, DON T MD
JACKSON
MS
49
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04882355
1306236617
CANNON, DONNA FNP-C
MANTACHIE
MS
03123057
1801082409
CANNON, HEATHER S MD
PHILADELPHIA
MS
05631036
1124412085
CANNON, VICTORIA A MD
JACKSON
MS
00121913
1215022470
CANTRELL, JOHN A MD
TUPELO
MS
00120651
1588699839
CANTRELL, JOHN E MD
OXFORD
MS
04750080
1235520693
CAO, TONY N PA-C
LAUREL
MS
04635519
1891709200
CAPEL, CHRISTOPHER MD
GREENWOOD
MS
01021322
1639140718
CAPPLEMAN, SUSAN D FNP
RIPLEY
MS
00011092
1952371387
CAPPLEMAN, TROY MD
RIPLEY
MS
06880276
1033559430
CAPRA, CARTER L MD
JACKSON
MS
04988734
1205052164
CARAWAY, CHAD D FNP
LAUREL
MS
00115571
1407989619
CARBO, DANA L MD
JACKSON
MS
08284523
1629207196
CARDACIOTTO, HELEN V DDS
BILOXI
MS
04575251
1609288141
CARDEN, NICOLE E MD
JACKSON
MS
02038245
1740643360
CARDENAS JR, CESAR MD
JACKSON
MS
09139099
1619187697
CARDENAS, RAUL J MD
SOUTHAVEN
MS
06054271
1134112394
CARDER, BETTE CFNP
TUPELO
MS
09277776
1932561974
CAREY, ALBERT E MD
JACKSON
MS
06601819
1184786717
CARLISLE, DIANE C WHNPB
GREENVILLE
MS
05728092
1215263652
CARLISLE, LAUREN J CFNP
COLUMBUS
MS
00880114
1467542241
CARLSON, JOHN D OD
HERNANDO
MS
01586524
1609865682
CARLSON, MATTHEW A MD
GULFPORT
MS
06486396
1730476078
CARLTON, CHRISTOPHER H DMD
AMORY
MS
00014321
1730110057
CARLTON, FREDERICK B MD
GRENADA
MS
08935039
1245466242
CARLTON, JOHN B DMD
WOODVILLE
MS
02024340
1518369180
CARLTON, LYNDSEY E FNP-B
BYRAM
MS
00120404
1972510287
CARLTON, SCOTT A
COLUMBIA
MS
02037369
1225397961
CARMEAN, JORDAN B ACNP-
JACKSON
MS
50
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08326827
1922271600
CARNATHAN, DORTHA L FNP
TUPELO
MS
00018182
1336235480
CARNER, DAVID V
BROOKHAVEN
MS
02032768
1427439835
CARNEY, DANIEL R DMD
ACKERMAN
MS
09154087
1306894779
CARNEY, DAVID O MD
HOUSTON
MS
00660290
1942213848
CARNEY, KAREN M DDS
JACKSON
MS
05908062
1679788558
CARNEY, TIMOTHY T DMD
ACKERMAN
MS
06955358
1043638869
CARNEY, WENDELL T NP
BAY SPRINGS
MS
04527208
1316109218
CARPENTER, CHASITY S MD
STARKVILLE
MS
05731372
1679934624
CARR, CARMEN NP
GULFPORT
MS
07254388
1568742146
CARR, DEANDRE M OD
BYRAM
MS
00017378
1093887945
CARR, GARY D MD
HATTIESBURG
MS
00015845
1053351692
CARR, JAMES H MD
VICKSBURG
MS
06437250
1871935189
CARR, JASON E NP
CARRIERE
MS
04438724
1073716825
CARR, MARTIN W NP
CARRIERE
MS
08750525
1124403001
CARRERE, JADE D NP
JACKSON
MS
02430223
1265828289
CARRERE, JONATHAN M MD
JACKSON
MS
00120078
1679562730
CARROLL JR, DAVID R MD
JACKSON
MS
05130237
1093157414
CARROLL, AMY L MSN
JACKSON
MS
00120136
1003846353
CARROLL, CHARLES S DO
JACKSON
MS
09971842
1215100011
CARROLL, CLINTON M MD
JACKSON
MS
01322061
1770974016
CARROLL, JILLIAN F PA-C
LAUREL
MS
06027230
1548471956
CARROLL, JONATHAN D MD
JACKSON
MS
09523036
1639482672
CARROLL, KRISTIN C CFNP
FLOWOOD
MS
06688263
1124247341
CARROLL, MATTHEW MD
OCEAN SPRINGS
MS
09379223
1154522050
CARROLL, PAULA
CANTON
MS
08934772
1427501857
CARROLL, VICTORIA L PMHNP
SOUTHAVEN
MS
07125342
1780967596
CARROLL, WHITNEY J FNPBC
SMITHVILLE
MS
02774068
1649342585
CARROLL, WILLIAM S
TUPELO
MS
51
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125783
1760453823
CARRON, JEFFREY D MD
JACKSON
MS
04372879
1578986915
CARSON, CHRISTOPHER A NP
JACKSON
MS
02278830
1356325393
CARSON, WILLIAM F MD
JACKSON
MS
00154731
1124456850
CARSON-GRIFFIN, AMANDA FNP
JACKSON
MS
05476851
1497827695
CARTER III, DENVER L
MAGEE
MS
02631306
1023216629
CARTER JR, WILLIAM R MD
STARKVILLE
MS
02251047
1497918825
CARTER, ANDREA M MD
HATTIESBURG
MS
06979775
1922481522
CARTER, ANNA C MD
JACKSON
MS
03275847
1902868961
CARTER, BENJAMIN T MD
KOSCIUSKO
MS
05880549
1609188911
CARTER, CORY MD
PASCAGOULA
MS
00117738
1114958089
CARTER, JAMES M MD
OCEAN SPRINGS
MS
02154265
1053342352
CARTER, JANELL G FNP
MAGEE
MS
06573501
1265574859
CARTER, JOHN G MD
BILOXI
MS
04232560
1760535553
CARTER, KEITH L MD
JACKSON
MS
03701533
1184018103
CARTER, KRISTEN T MD
JACKSON
MS
09684296
1396768982
CARTER, KRISTINE MD
GULFPORT
MS
00229550
1558393843
CARTER, MAURICE NP
MAGEE
MS
00125742
1053371807
CARTER, MICHAEL H M.D.
GREENWOOD
MS
08476342
1649477191
CARTER, ROBERT L MD
PONTOTOC
MS
06826705
1528246576
CARTER, STACEY A MSN
JACKSON
MS
05579706
1497068118
CARTER, STACEY R DMD
GULFPORT
MS
00115862
1275587206
CARTER, TOMIA D FNP-C
MOSELLE
MS
00115576
1669585774
CARTER, WM LARKIN MD
RIDGELAND
MS
02978042
1568914505
CARTER-MCREYNOLDS, RITA F FNP
UNION
MS
00017651
1588664510
CARTWRIGHT, CLIFTON C MD
BOONEVILLE
MS
00660375
1306047972
CARTY, LESLIE A DMD
WESSON
MS
01509089
1962676379
CARVER, LAURA J MD
OLIVE BRANCH
MS
00126164
1134239171
CASANO, PETER J MD
FLOWOOD
MS
52
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118583
1396776480
CASANO, ROSALIE A MD
WHITFIELD
MS
03727355
1508009382
CASE, BETHANY B N.P.
JACKSON
MS
02175524
1891992061
CASE, RYAN C MD
BROOKHAVEN
MS
00122933
1962406959
CASELLI, SUSAN B FNP
HOLLANDALE
MS
07770711
1598843997
CASEY, DAVID B MD
MCCOMB
MS
05439877
1730387655
CASEY, LEE D DMD
LIBERTY
MS
06173013
1740206515
CASHWELL, LEIGH A MD
LUCEDALE
MS
00660294
1689719486
CASKEY, CHARLES J DMD
JACKSON
MS
02581267
1083926141
CASKEY, CURTIS P DMD
JACKSON
MS
06203094
1508021007
CASKEY, ROBERT MD
HAZLEHURST
MS
00119732
1427032754
CASSADA, MARGARET K MD
GREENVILLE
MS
00125788
1760476857
CASSELL, DONNA K MD
JACKSON
MS
09300810
1427269331
CASSELL, MATTHEW W MD
MERIDIAN
MS
02604808
1497926265
CASSELL-COCHRAN, LINDY N FNP
BAY SPRINGS
MS
04528386
1932425865
CASTANEDA, JORGE L MD
JACKSON
MS
00012082
1568408896
CASTILLA, MAGOLIA A MD
JACKSON
MS
01559383
1003848755
CASTILLO, DANIEL MD
JACKSON
MS
07421365
1538179536
CASTILLO, JAIME MD
VARDAMAN
MS
00116412
1437122751
CASTLE, MONA M
OXFORD
MS
08655383
1538138391
CASTLE, WILLIAM B MD
JACKSON
MS
00124405
1407854417
CASTLEBERRY, GORDON M
STARKVILLE
MS
00532323
1205275062
CASWELL, BRIAN W NP
JACKSON
MS
08876761
1932522281
CASWELL, JASON W PA-C
COLUMBUS
MS
00060269
1366867996
CASWELL, WAYNE DDS
JACKSON
MS
09183267
1609800986
CATAFYGIOTU, JOHN DPM
OLIVE BRANCH
MS
00013197
1922031616
CATER, ROBERT J MD
MERIDIAN
MS
00660094
1942380480
CATHEY, DERAN
COLDWATER
MS
03852767
1811918246
CATHEY, GENE D MD
LOUISVILLE
MS
53
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04033292
1770689630
CATHEY, RENE H FNP
RALEIGH
MS
02681853
1164869897
CATLEDGE, KRISTEN C DMD
OKOLONA
MS
07680553
1194178475
CATLETTE, BRANTLEY W NP
RULEVILLE
MS
00931060
1275073157
CATLETTE, MARTHA PMHNP
GREENWOOD
MS
09987854
1538131594
CAUDILL, JONATHAN MD
TUPELO
MS
00112154
1790777142
CAUSEY II, JACK Q MD
GULFPORT
MS
07883341
1649573783
CAUSEY, SHERRIKEE FNP
JACKSON
MS
00757226
1134589930
CAUTHEN, REBECCA L ACNP
FLOWOOD
MS
02307827
1417186347
CAUTHEN, WILLIAM MD
TUPELO
MS
00102370
1588032775
CAVANAUGH, AMANDA K MSN
JACKSON
MS
07429242
1588929855
CEASE, ALAN T MD
MERIDIAN
MS
02335760
1588015903
CECCORULLI, TINA J NP
OCEAN SPRINGS
MS
00114830
1225052863
CEGIELSKI, CAROLYN H DO
LAUREL
MS
04136808
1427421288
CESARE, CARIE WHNP-
CLARKSDALE
MS
00114569
1063408409
CESARE, CHARLES D
CLARKSDALE
MS
05827704
1710169743
CESARIO, JASON S MD
CORINTH
MS
04001764
1063618080
CHALASANI, SREELATHA MD
JACKSON
MS
03929248
1902260045
CHAMBERLAIN, NICHOLAS D MD
JACKSON
MS
08456391
1235373093
CHAMBERLAIN, RYAN J MD
GULFPORT
MS
04571015
1508897794
CHAMBERS III, ARTHUR L MD
TUPELO
MS
03581557
1023186038
CHAMBERS, LINDA P CFNP
CAMDEN
MS
05075874
1225236946
CHAMBERS, MICHAEL J MD
JACKSON
MS
03009719
1578772331
CHAMBLEE, MICHAEL A MD
MERIDIAN
MS
03101367
1396195848
CHAMBLISS, LIEUTITIA K FNP
FLOWOOD
MS
02181091
1083815112
CHAN, CHUN K MD
OLIVE BRANCH
MS
04778891
1467644773
CHAN, YIESHAN M MD
JACKSON
MS
00124734
1073599437
CHANCE, JOSEPH W
OLIVE BRANCH
MS
00119881
1437264504
CHANCE, RICKEY DO
BILOXI
MS
54
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02377779
1053328385
CHANCELLOR, BILLY C NP
HATTIESBURG
MS
00828232
1043691074
CHANCELLOR, GAIL S NP
JACKSON
MS
02078785
1710366992
CHANDAK, SARIKA C MD
JACKSON
MS
02877821
1417159963
CHANDLER, ANDREW M DO
OXFORD
MS
00125424
1083650345
CHANDLER, ANGELA L MD
WHITFIELD
MS
08676015
1831574888
CHANDLER, BILLY M NP
EUPORA
MS
07873865
1780996777
CHANDLER, DERRICK L MD
JACKSON
MS
00126180
1447350152
CHANDLER, JAMES K MD
JACKSON
MS
09739384
1538171566
CHANDLER, JOHN M DMD
MAGEE
MS
03321871
1740655091
CHANDLER, KAJUANDRA K FNP
DREW
MS
CHANDLER, LISA L MD
OXFORD
MS
00123848
Jun 11, 2017
03159856
1043496235
CHANDRAN, RAVI DMD
JACKSON
MS
03882550
1124329016
CHANDRAPPA, VANI K MD
OLIVE BRANCH
MS
08287769
1538543400
CHANDRASHEKAR, ARVIND MD
JACKSON
MS
00126910
1699716241
CHANEY, GERALDINE B
JACKSON
MS
00010477
1588715940
CHANEY, JAMES P MD
AMORY
MS
00060033
1821150194
CHANEY, MARTIN V DMD
VICKSBURG
MS
01739781
1306270269
CHANEY, MEAGAN N FNP
NEWTON
MS
00650847
1720087257
CHANG, JOON K MD
COLUMBUS
MS
00119796
1649363656
CHANG, KI M
SOUTHAVEN
MS
05802576
1033208889
CHANG, RANDALL W PA
GULFPORT
MS
00017484
1487827853
CHANIN, LOUIS R DO
SOUTHAVEN
MS
08457305
1922325190
CHAPEL, ROSS J MD
JACKSON
MS
02972802
1952630089
CHAPMAN II, CLYDE R MD
TERRY
MS
05238528
1255563052
CHAPMAN, ANNE R FNP
JACKSON
MS
09451527
1811931363
CHAPMAN, JASMIN R DDS
JACKSON
MS
03209211
1427064344
CHAPMAN, JOY A
HOUSTON
MS
00016336
1457341729
CHAPPELL, JOSEPH J MD
TUPELO
MS
55
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00121295
1114965936
CHARD, CHRISTINE K
LAUREL
MS
00120591
1912913757
CHARD, DANA
MERIDIAN
MS
08857001
1790958213
CHARD, RACHEL S MD
MERIDIAN
MS
09730307
1073594743
CHARLES, CHRISTOPHER MD
MCCOMB
MS
05431595
1255360186
CHAROGLU, CONSTANTINE P MD
HATTIESBURG
MS
00124627
1588623532
CHASE, DAVID G MD
BOONEVILLE
MS
06677544
1871752998
CHASTAIN, ELIZABETH C MD
JACKSON
MS
06158839
1811355605
CHATHAM, TARAH V CNP
HATTIESBURG
MS
00660414
1518026228
CHATTERJEE KIRK, PIA
JACKSON
MS
00838251
1346651163
CHATTERJEE, JAHNAVI MD
JACKSON
MS
03873541
1356458111
CHAUBE, SANJAY MD
BAY ST. LOUIS
MS
05406731
1467681924
CHAUDRY, JOSEPH R MD
JACKSON
MS
01787042
1588621254
CHAUHAN, RAVI D MD
SOUTHAVEN
MS
00019411
1407948193
CHAUVIN, JOHN C M.D.
BATESVILLE
MS
00880152
1467423210
CHEATHAM, DAVID W OD
WEST POINT
MS
00123979
1609989102
CHECHELASHVILI, ARCHIL MD
STARKVILLE
MS
09854713
1376750372
CHEEMA, QASIM M MD
JACKSON
MS
09039712
1124209663
CHEEMA, YASER MD
SOUTHHAVEN
MS
00017570
1033166756
CHEN, CHING J
JACKSON
MS
03457828
1639580707
CHEN, JIAN MD
JACKSON
MS
02378519
1073830790
CHEN, TIMOTHY C MD
JACKSON
MS
00119717
1639110737
CHEN, YEN CHOU J MD
OCEAN SPRINGS
MS
00018006
1083676548
CHENEY, BEN W MD
BILOXI
MS
03453800
1093065419
CHENEY, CATHERINE D NP
JACKSON
MS
05838078
1114953692
CHENG, MEI-CHANG MD
HATTIESBURG
MS
03008777
1437210341
CHERNECKY, RICHARD E MD
OCEAN SPRINGS
MS
04755740
1871945816
CHERRY, MEAGAN C FNP
BOONEVILLE
MS
06472261
1467618918
CHESSER, JANET L NP-C
COLUMBUS
MS
56
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08175863
1114248424
CHEUNGPASITPORN, WISIT MD
JACKSON
MS
03437244
1104937481
CHEVALIER, STEVEN P MD
MADISON
MS
00011265
1649228529
CHEVIS, BERTIN C MD
BAY SAINT LOUIS
MS
00119073
1104093723
CHEW, GWENEVERE FNP
CLARKSDALE
MS
00112108
1871534008
CHIARITO, SUSAN A M.D.
VICKSBURG
MS
00124422
1326003005
CHIEMPRABHA, ALBERT
FLOWOOD
MS
01255079
1427459817
CHILDRESS, CANDANCE J NP
CANTON
MS
07270080
1922069921
CHILDRESS, CURTIS S
HATTIESBURG
MS
00014256
1821186222
CHILDREY, GREGORY W
COLUMBUS
MS
00536228
1508184706
CHILDS, JOSEPH H MD
HATTIESBURG
MS
00729511
1205276623
CHINTHAPARTHI, SIREESHA MD
JACKSON
MS
04003571
1750720363
CHISM, LAKEISHA R MD
TUPELO
MS
03731854
1659353944
CHISOLM, ALECIA P FNP
NEWTON
MS
06853522
1134572357
CHOATE, AMBER A NP-C
BOONEVILLE
MS
06677857
1487064697
CHOATE, CODY C DO
HATTIESBURG
MS
07052768
1609028851
CHOI, HYUNG S MD
JACKSON
MS
07488727
1720032436
CHOUFANI, DANI I MD
JACKSON
MS
00122276
1912956632
CHOUTEAU, STEPHEN L MD
BRANDON
MS
04505519
1215245667
CHOW, MATTHEW J DMD
CLARKSDALE
MS
03536521
1497983894
CHOW, MATTHEW K DDS
CLINTON
MS
02423047
1558774174
CHOW, STEPHEN R MD
JACKSON
MS
06534366
1568469237
CHOWDHARY, SUSHMA
HORN LAKE
MS
00930760
1164583001
CHOWDHARY, YASHWANT MD
CLARKSDALE
MS
04657738
1942611025
CHREA, BOPHA MD
JACKSON
MS
04481354
1841482197
CHRESTMAN, SHERRY M NP
GRENADA
MS
00660076
1689680266
CHRISMAN, JAMES L DDS
TUPELO
MS
00118142
1811938699
CHRIST, ELIZABETH A
JACKSON
MS
07822716
1336171719
CHRISTEN, NEIL L MD
GRENADA
MS
57
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00119847
1083674378
CHRISTENSEN, VERN M DPM
AMORY
MS
06752203
1902100654
CHRISTIAN, AVA P FNP-C
JACKSON
MS
00574531
1932121662
CHRISTIAN, CLAIBORNE A MD
SOUTHAVEN
MS
05985510
1245230887
CHRISTIAN, ROBIN NP
NATCHEZ
MS
00126181
1760446447
CHRISTIAN, RONNIE MD
KOSCIUSKO
MS
00017537
1669455523
CHRISTIAN, THOMAS W M.D.
JACKSON
MS
00122660
1033207360
CHRISTIE, MICHAEL J
OCEAN SPRINGS
MS
03806753
1770021982
CHRISTOPHER, KYLE T PA
GREENVILLE
MS
01739501
1205220217
CHRISTOPHER, WADE O MD
JACKSON
MS
02054561
1386020113
CHRISTY, STEFANIE T DNP,
COLUMBUS
MS
09256751
1972957405
CHUGANI, PINKY R DO
JACKSON
MS
08856551
1053315481
CHUGH, DEEPAK K MD
TUPELO
MS
05674733
1811198005
CHUSTZ, PHILIP L MD
HATTIESBURG
MS
00115574
1114030137
CIRILLI, GARY A MD
RIDGELAND
MS
00015848
1669598561
CIRILLI, MICHAEL J MD
GREENVILLE
MS
01150749
1528378122
CIRINO, CASEY J NP
TUPELO
MS
04036718
1780610444
CISSE, SALOUM
RAYMOND
MS
02850365
1114305745
CLAIR, ELIZABETH J DO
JACKSON
MS
05509571
1508827205
CLANTON, REBECCA B NP
LEXINGTON
MS
00121176
1487704375
CLAPP JR, ROGER C MD
STARKVILLE
MS
00064689
1487769055
CLARENCE R AVERY II
PASCAGOULA
MS
05881753
1760519474
CLARK, ANNA PA
GULFPORT
MS
09004327
1720425416
CLARK, CHARLES S MD
JACKSON
MS
00114924
1336251271
CLARK, CHERRY G MD
HICKORY
MS
00087865
1831276278
CLARK, GRADY M JR
MERIDIAN
MS
00010245
1689696064
CLARK, HOWARD D MD
MORTON
MS
09529210
1093712556
CLARK, JAMES G MD
GULFPORT
MS
07876712
1639418486
CLARK, JAMES M CNP
JACKSON
MS
58
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08382849
1609287432
CLARK, JEB S MD
JACKSON
MS
00116404
1376643247
CLARK, JEFFREY G MD
BROOKHAVEN
MS
05330780
1104201649
CLARK, JENNA E NP
JACKSON
MS
05805509
1619035029
CLARK, KARMEN R PA-C
D'IBERVILLE
MS
00060061
1568439107
CLARK, LINDBERG DDS
GULFPORT
MS
09356869
1114317054
CLARK, LISA NP
NEW ALBANY
MS
02656862
1770543092
CLARK, MAURICE A OD
TUPELO
MS
02670006
1285910653
CLARK, MELINDA L NP
COLUMBUS
MS
09524849
1386778520
CLARK, MICHAEL V DDS
GRENADA
MS
03320831
1619388659
CLARK, PAUL R MD
JACKSON
MS
00116455
1518944198
CLARK, ROBERT MD
MERIDIAN
MS
09458734
1841682044
CLARK, SAMANTHA S FNP
MERIDIAN
MS
05074201
1558772335
CLARK, SARA E MD
JACKSON
MS
04301531
1427174374
CLARK, SONYA M DO
JACKSON
MS
00119638
1053408476
CLARK, STEVEN G MD
CLEVELAND
MS
00118813
1518987478
CLARK, WILLIAM G MD
LAUREL
MS
00115774
1265409064
CLARK, WINSTON C MD
SOUTHAVEN
MS
01653027
1659671089
CLARKE, JENNIFER R NP
GULFPORT
MS
04908776
1821474867
CLARKE, LINDSEY L CNP
JACKSON
MS
00120419
1538196936
CLARKE, MARCY L
JACKSON
MS
00121081
1285711978
CLARKSON, JAMES E MD
PASCAGOULA
MS
06778577
1205887338
CLATTERBUCK, RICHARD E MD
HATTIESBURG
MS
00115455
1194825513
CLAWSON, MARY E MD
BAY SPRINGS
MS
06824287
1265881007
CLAY, ADAM P FNP-C
PONTOTOC
MS
03334395
1730268764
CLAY, BRYAN M MD
JACKSON
MS
02027586
1891773545
CLAY, RICKY P MD
JACKSON
MS
00121402
1386621936
CLAYTON, TODD A MD
JACKSON
MS
00122565
1477557098
CLEARMAN, KEVIN C CFNP
HATTIESBURG
MS
59
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00116393
1124055488
CLEARMAN, PAULA S
PHILADELPHIA
MS
00123556
1518944560
CLEARMAN, SELENA B CFNP
HATTIESBURG
MS
01624232
1700142403
CLEARMAN, TINA D NP
MERIDIAN
MS
02752083
1699051508
CLEGG, ANGELA NP
OXFORD
MS
00089233
1568691509
CLEINMAN, ALYCIA A MD
JACKSON
MS
00122664
1912933672
CLEMENT, LARA MD
VICKSBURG
MS
02327355
1497986731
CLEMENTE, ETHEL G MD
JACKSON
MS
02222367
1932441987
CLEMENTS, JENNIFER H CFNP
STARKVILLE
MS
07329529
1023322765
CLEMMER, DEREK A DMD
TUPELO
MS
00880096
1396859054
CLEVELAND, CRAIG W OD
BOONEVILLE
MS
04484235
1750795886
CLEVELAND, JOY H FNP
VERONA
MS
07334806
1639380207
CLEVELAND, NICOLE D MD
JACKSON
MS
00977891
1497729768
CLIATT, THOMAS A DO
HATTIESBURG
MS
00126966
1730285602
CLIFFORD, ROSE E NP
HATTIESBURG
MS
00087765
1134198328
CLIFTON, DANNY R OD
LOUISVILLE
MS
00709836
1083043681
CLINE, JANA P NP
BRANDON
MS
02258379
1982758272
CLINGAN, ROBERT C MD
VICKSBURG
MS
00116700
1306896386
CLINTON, MARTHA M
ROBINSONVILLE
MS
00122354
1205937570
CLOY, JAMES A MD
JACKSON
MS
00064525
1407956873
CLOYD, DAVID B DDS
PRENTISS
MS
03006042
1497928592
CLUNAN, SHERI FNP C
PICAYUNE
MS
04728236
1437539830
CLYDE, KIMBERLY J NP
JACKSON
MS
08329836
1316009137
COATES, GLYNIS C PHY
PICAYUNE
MS
00118666
1972510212
COBB, DONNA
POPLARVILLE
MS
00115159
1346321189
COBB, THOMAS J MD
STARKVILLE
MS
00660356
1912082959
COBBINS, PRESTON L DDS
CANTON
MS
02933747
1225426927
COBERN, KRISTINA NP
BILOXI
MS
00539591
1225249766
COCHRAN, CURTIS W APRN
HATTIESBURG
MS
60
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09336715
1861761348
COCHRAN, DOMONIQUE N FNP
LUCEDALE
MS
00087907
1619944287
COCHRAN, GLENN M OD
QUITMAN
MS
09772036
1235210063
COCHRAN, MIRIAM L CNM
COLUMBUS
MS
09954520
1013996586
COCHRAN, RICHARD P MD
JACKSON
MS
06130899
1689780421
COCHRAN, SHELLEY R FNP
HATTIESBURG
MS
07020761
1659772556
COCILOVA, AMANDA K NP
FLOWOOD
MS
00285539
1184038499
COCILOVA, ASHLEY K NP
FLOWOOD
MS
04983840
1134163512
COCKRELL, LINDA C FNP
COLUMBIA
MS
02928257
1063838480
COCKRELL, TANYA S FNP B
STARKVILLE
MS
05135821
1477753929
COCKROFT, LINDA B CFNP
KOSCIUSKO
MS
08904726
1295941615
COFFEY, JORDAN T MD
OLIVE BRANCH
MS
00117481
1902904584
COGGINS, KAY T
WEST POINT
MS
00016981
1255338760
COHEN, EDWARD R
GULFPORT
MS
01850584
1881073062
COILE, CLIFFORD E MD
JACKSON
MS
07551225
1255530267
COKER, DEANNA DO
TUPELO
MS
03088367
1376609990
COKER, MELANIE P
JACKSON
MS
04774531
1063709525
COLBERT, CIERRA C MD
HATTIESBURG
MS
03174823
1316980931
COLBERT, PATRIZIA MD
TYLERTOWN
MS
04556055
1629264544
COLE, ALAN K MD
JACKSON
MS
00110709
1659460384
COLE, CRAIG MD
VICKSBURG
MS
08576879
1366733164
COLE, ERICA R FNP
MERIDIAN
MS
00120132
1770553430
COLE, JAMES W MD
CORINTH
MS
07655097
1962777896
COLE, JENNA K FNP-C
ELLISVILLE
MS
06225817
1588053052
COLE, JUSTIN L NP
LAUREL
MS
00126024
1235273178
COLE, KAREN F
JACKSON
MS
09773780
1306967161
COLE, MELISSA G DMD
FLORENCE
MS
00123929
1982646725
COLE, RICHARD K MD
ARMORY
MS
02852251
1558386920
COLE, RONJA G CFNP
BOONEVILLE
MS
61
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09483701
1023294527
COLE, SAMUEL W MD
HATTIESBURG
MS
09927394
1639107121
COLE, THOMAS P
HATTIESBURG
MS
00125566
1790792059
COLE, TIMOTHY L MD
HATTIESBURG
MS
00660283
1801831938
COLEMAN JR, ALEXANDER DMD
LAUREL
MS
00121946
1770512303
COLEMAN, AMY B MD
MERIDIAN
MS
00125851
1942241922
COLEMAN, BRANDI MD
GULFPORT
MS
00125342
1881685782
COLEMAN, BRANDON L DO
HATTIESBURG
MS
07205590
1003153966
COLEMAN, BRITTANY N NP
GULFPORT
MS
00060271
1255660593
COLEMAN, JAMES DMD
LIBERTY
MS
00115836
1881891786
COLEMAN, JAMES P MD
BRANDON
MS
00660436
1477665065
COLEMAN, JASON K DMD
OXFORD
MS
09501091
1336147271
COLEMAN, LEE W MD
GREENWOOD
MS
00124307
1447258694
COLEMAN, MICHAEL W MD
GREENWOOD
MS
01830721
1871714477
COLEMAN, ROBERT M DDS
VICKSBURG
MS
00114726
1225079759
COLEMAN, ROBERT M MD
CLARKSDALE
MS
03056099
1710169420
COLEMAN, ROBERT V MD
FLORENCE
MS
01776730
1275690315
COLEMAN, ROBIN H FNP
STREET
MS
00660349
1033249867
COLEMAN, RODERICK L DMD
VICKSBURG
MS
06785301
1194967349
COLEMAN, SHELLI I DO
FULTON
MS
02559022
1235523838
COLEMAN, TASHA N MD
JACKSON
MS
00834790
1144500091
COLENBERG-EAKINS, LATOYA D DMD
TUPELO
MS
02137839
1407081862
COLLADO, JERRY C CFNP
RIDGELAND
MS
09872218
1679665640
COLLEY III, BYRON J MD
JACKSON
MS
04872353
1992892020
COLLIER III, ANDERSON B MD
JACKSON
MS
06874545
1396928222
COLLIER, CHARLENE H MD
JACKSON
MS
00660152
1376672618
COLLIER, JOHN A
OXFORD
MS
00010869
1508893074
COLLINS JR, ROSS E
TUPELO
MS
00028386
1093002743
COLLINS, ANDREA J MD
JACKSON
MS
62
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00087003
1679682835
COLLINS, C. CHRIS
VICKSBURG
MS
00119430
1972655439
COLLINS, CHARLES L MD
OCEAN SPRINGS
MS
03936014
1760692917
COLLINS, CHRISTINA D MD
COLUMBUS
MS
02504711
1932318243
COLLINS, CLINTON W MD
JACKSON
MS
00125535
1225070162
COLLINS, CURTIS L
TUPELO
MS
02120020
1790929388
COLLINS, JAMES B MD
JACKSON
MS
00011793
1164491924
COLLINS, LARRY L MD
JACKSON
MS
06052845
1780089649
COLLINS, LATASHA M FNPBC
JACKSON
MS
05304378
1659731602
COLLINS, LYNN NP
GULFPORT
MS
02879874
1144532086
COLLINS, MICHAEL D NP
NEWTON
MS
00122294
1902829609
COLLINS, NANCY K M.D.
PEARL
MS
05452091
1437162690
COLLINS, NATIVEL J NPC
VERNA
MS
00123006
1124003785
COLLINS, ROBERT K MD
MISSISSIPPI STATE
MS
00011131
1356339352
COLLINS, SHARON M MD
TYLERTOWN
MS
00115383
1811080518
COLLIPP, DAVID C
FLOWOOD
MS
00011925
1962463968
COLTHARP, JAMES R MD
HATTIESBURG
MS
02107231
1457462020
COLVILLE, AMBER D MD
OCEAN SPRINGS
MS
00119469
1619988243
COLVIN, IV, GREENE B MD
SOUTHAVEN
MS
01800228
1841678471
COLVIN, JOHN R MD
JACKSON
MS
06072763
1306146352
COMANS, BLAIR A FNP
COLLINSVILLE
MS
00119489
1356399513
COMBEST, FELTON E MD
CLEVELAND
MS
07550533
1265584189
COMBS III, HORACE E DMD
PICAYUNE
MS
01751593
1467616565
COMER BROWN, AMANDA L NP
CORINTH
MS
02325756
1053618710
COMER, RICHARD FNP
CORINTH
MS
04876809
1003014606
COMMISKEY, STEPHEN W MD
WHITFIELD
MS
00333823
1164696951
COMPTON, ASTRID Y MD
HATTIESBURG
MS
04280069
1316110745
COMPTON, NATHAN MD
HATTIESBURG
MS
00121014
1578591186
COMPTON, PHILLIP D
GULFPORT
MS
63
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02856081
1043449598
COMPTON, SETH MD
JACKSON
MS
00119423
1255419263
CONDON, MARK A MD
FLOWOOD
MS
00016765
1497761241
CONERLY, DONALD V MD
PETAL
MS
00577519
1396057139
CONERLY, SARAH E MD
JACKSON
MS
00115155
1174530448
CONERLY, STEPHEN L M.D.
HATTIESBURG
MS
04539889
1174878193
CONERLY, TEARRAH FNP
MERIDIAN
MS
08453873
1285065292
CONERLY, TERESA NP-C
MONTICELLO
MS
05506211
1912347105
CONFAIT, CASSIE N MD
MERIIDAN
MS
04959881
1649666744
CONLEY DONALDSON, SHEREE L FNP-B
LAUREL
MS
00103326
1275880601
CONN, HEATHER FNP
RIDGELAND
MS
07407051
1285049254
CONN, KELLI E CNP
JACKSON
MS
02623217
1790916294
CONN, RHETTA A OD
COLDWATER
MS
00122875
1659307296
CONNELL, NORMAN L MD
CARTHAGE
MS
07288757
1952522583
CONNER, DAVID J DDS
LUCEDALE
MS
06387772
1639313711
CONNER, DAVID T MD
TUPELO
MS
03306702
1588873798
CONNER, JEANA E DDS
LUCEDALE
MS
09878077
1316056567
CONTE, EUGENE T DO
PETAL
MS
08027230
1679775944
CONVERTINO, COURTNEY MD
RIDGELAND
MS
09627870
1528431145
CONWILL, KELLI E FNP
JACKSON
MS
00118958
1356440721
COOK JR, WILLIAM S MD
NATCHEZ
MS
03829594
1366527558
COOK, AMANDA H MD
FLOWOOD
MS
07908891
1215136296
COOK, CHRISTOPHER E OD
RIDGELAND
MS
01754550
1629203153
COOK, CLIFFORD J DMD
BILOXI
MS
07781796
1003069113
COOK, CRYSTAL S NP
FAYETTE
MS
00660112
1174608368
COOK, HENRY W DMD
BRANDON
MS
00116548
1225033590
COOK, JEFFREY N MD
MERIDIAN
MS
07400054
1730371964
COOK, JENNIFER L CNP
BRROKHAVEN
MS
08172301
1285663633
COOK, JOE C MD
JACKSON
MS
64
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00017247
1588613046
COOK, JOHN J MD
BRANDON
MS
00112394
1033253877
COOK, JOHN W
FLOWOOD
MS
08083594
1831161397
COOK, KENNETH R FNP
TUPELO
MS
00880118
1457360679
COOK, MICHAEL G
SOUTHAVEN
MS
00660125
1801899620
COOK, MICHAEL S DMD
LEAKESVILLE
MS
09455703
1780624510
COOKSEY, BOBBIE
WAYNESBORO
MS
06829717
1851731277
COOLEY, CHAD E MD
FLOWOOD
MS
04103763
1194733543
COOLEY, CHRISTOPHER L MD
HATTIESBURG
MS
06782894
1538208830
COOLEY, JULIE CFNP
JACKSON
MS
00060560
1821203613
COOLEY, RAY L DDS
WIGGINS
MS
03455263
1164891438
COOLEY, SARA S NP
IUKA
MS
06900863
1831550607
COOLIDGE, JESSICA NP
GULFPORT
MS
00027799
1407962103
COON, DAVID T MD
OXFORD
MS
09677276
1043664972
COOPER, ANNA M NP
STARKVILLE
MS
00878207
1992712244
COOPER, ARLEN D NP
FLOWOOD
MS
01585562
1649653775
COOPER, HANNAH M NP
KOSCIUSKO
MS
00126712
1124095914
COOPER, JADA W CFNP
GULFPORT
MS
00012043
1588699789
COOPER, JAMES M
TUPELO
MS
03381288
1073831327
COOPER, JANICE CFNP
KOSCUISKO
MS
07302234
1043624232
COOPER, JENNIFER A MD
JACKSON
MS
02079217
1023267630
COOPER, KEVIN S MD
PASCAGOULA
MS
00126107
1750316881
COOPER, KIM FNP
JACKSON
MS
00111401
1023078086
COOPER, LARRY D MD
CANTON
MS
04086082
1033193065
COOPER, MELISSA E NP
COLUMBUS
MS
00016342
1609982412
COOPER, ROBERT F MD
OXFORD
MS
05384293
1174730519
COOPER, TANA K DO
D'IBERVILLE
MS
00115320
1013013648
COOPER, TOM S
CLARKSDALE
MS
04905851
1871589994
COPE, JOHN W MD
PHILADELPHIA
MS
65
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07605756
1518378686
COPE, KEVIN A DO
JACKSON
MS
00064746
1760517544
COPE, LEE L DDS
JACKSON
MS
01639756
1326153149
COPELAND III, GEORGE E MD
JACKSON
MS
00060418
1811987258
COPELAND, VINCENT H DDS
TUNICA
MS
00121128
1023036381
CORBIN, KATHY CFNP
CARTHAGE
MS
03888016
1386847465
CORDELL III, CLAYTON W MD
TUPELO
MS
00122205
1710961982
CORDER, FREDRICK A MD
CORINTH
MS
00012870
1285656850
CORDER, JAMES E
GULFPORT
MS
05226555
1316963911
CORDLE, MARY E ACNP
PASGAGOULA
MS
09202512
1619130952
CORLEY, JOHN J MD
JACKSON
MS
01730334
1003070863
CORLEY, MARY K MD
JACKSON
MS
04372033
1669608618
CORMAN, ADAM R MD
GULFPORT
MS
05652778
1457733552
CORNELIUS, MOLLIE B CFNP
COLUMBUS
MS
07009711
1700285491
CORRERO, JACKIE L NP
SOUTHAVEN
MS
00116018
1215087515
COSUE III, LAMBERTO G MD
RULEVILLE
MS
02672270
1124439757
COSULICH, MICHAEL T MD
JACKSON
MS
00123944
1164466082
COTTEN, VERNON R MD
JACKSON
MS
00011136
1659363067
COTTER, GREGORY W MD
SOUTHAVEN
MS
07928724
1780935841
COTTON, KATRINA C FNP
GREENWOOD
MS
00820364
1902832538
COTTON, RENITA F MD
LEXINGTON
MS
00186847
1679832075
COTTRELL, JESSE N MD
JACKSON
MS
00112109
1154410900
COUGHLIN, WILLIAM D MD
WHITFIELD
MS
05752094
1235581513
COULSON, MELISSA B NP
RIDGELAND
MS
07087716
1467858373
COUNCE, CORTNEY H PA
SOUTHAVEN
MS
01804012
1275508962
COUNTS, LAWRENCE D MD
CLARKSDALE
MS
01173369
1407235682
COURTNEY, JEREMY D MD
JACKSON
MS
09302042
1134259765
COURTNEY, REBECCA C DMD
WIGGINS
MS
00120639
1417039546
COUVILLON III, LARRY C MD
GULFPORT
MS
66
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01682788
1689676298
COVAULT, MICHEAL MD
JACKSON
MS
00110083
1184665580
COVIN, FISHER A
HATTIESBURG
MS
06276379
1821186917
COVINGTON, MEREDITH H NP-C
JACKSON
MS
09571516
1760661821
COWAN, ANESHA M FNP
HORN LAKE
MS
09673332
1164828372
COWAN, KELLY D NP
BILOXI
MS
00112342
1124009840
COWART, MARY A MD
MERIDIAN
MS
05556724
1710056130
COWDEN II, ARTHUR M DO
GULFPORT
MS
01106501
1396186177
COX, KASEY M MD
JACKSON
MS
06429080
1356514988
COX, MICHAEL J MD
HATTIESBURG
MS
09937001
1104271931
COX, RHONDA J CNP
PRENTISS
MS
00116162
1265467724
COX, ROBERT D MD
JACKSON
MS
05570710
1457504730
COX, SUZANNE CFNP
PURVIS
MS
00115707
1720189459
COXWELL, LEAANN
FOREST
MS
06872882
1801896741
COYLE, JANET A M.D.
AMORY
MS
07374293
1851780597
CRADDOCK, ASHLEY M
HORN LAKE
MS
02953242
1164734406
CRADDOCK, PUJA M MD
JACKSON
MS
08252334
1104862259
CRAFT, BARBARA S MD
JACKSON
MS
06672579
1245431493
CRAFT, BRANDON J NP
VICKSBURG
MS
00624501
1184753485
CRAFT, JASON A MD
JACKSON
MS
03733340
1033197934
CRAICI, IASMINA M MD
JACKSON
MS
00550909
1316309479
CRAIG, CAROLYNE M MD
JACKSON
MS
07252041
1013351436
CRAIG, LAUREN M MD
JACKSON
MS
00112173
1932189818
CRAIG, MARK H MD
TUPELO
MS
05138854
1831597202
CRAIG, MARKUS D NP
BAY SAINT LOUIS
MS
02570216
1518275379
CRAIG, MATTHEW J MD
JACKSON
MS
06023540
1720163066
CRAIG, THOMAS E MD
BILOXI
MS
01128508
1568625416
CRAIN, SARAH F DDS
HATTIESBURG
MS
03305328
1811955693
CRANDELL, KEVIN L MD
OXFORD
MS
67
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00734221
1700175353
CRANE, DANIEL K MD
HATTIESBURG
MS
05680375
1962801779
CRANFORD, AMANDA G FNP
MERIDIAN
MS
07736855
1639517279
CRANFORD, CATHERINE C MD
JACKSON
MS
02879887
1134523111
CRAPPS, CARLI O MSN
JACKSON
MS
00115786
1689780405
CRASTO, DAVID W MD
FLOWOOD
MS
00121387
1750325528
CRAVEN, KENNETH FNP
LAUREL
MS
01989761
1205178241
CRAVEN, SHANNA A ACNP
JACKSON
MS
01506817
1750571741
CRAWFORD JONES, KARMEN L OD
MADISON
MS
00018568
1134137532
CRAWFORD JR, EVERETT H MD
HATTIESBURG
MS
08576764
1154511152
CRAWFORD, ADAM R OD
CANTON
MS
00126840
1720048002
CRAWFORD, ALAN G PA-C
OCEAN SPRINGS
MS
02204037
1861874182
CRAWFORD, ALI D NP
POTTS CAMP
MS
05874544
1497019863
CRAWFORD, KRISTEN MD
MADISON
MS
00115497
1447287107
CRAWFORD, STEPHEN C
JACKSON
MS
09155274
1518003342
CRAWFORD, VIRGINIA M MD
HATTIESBURG
MS
07804833
1265472203
CREASY, STEVEN R MD
MERIDIAN
MS
00117464
1861470627
CRECELIUS, LAURA J MD
CORINTH
MS
04338768
1396902409
CREECH, TONYA G DO
HATTIESBURG
MS
00013582
1578538591
CREEKMORE III, SAMUEL J
NEW ALBANY
MS
02423720
1801893243
CREIGHTON, AMERY J MD
GULFPORT
MS
00114765
1942210497
CRENSHAW III, CHARLES N
FLOWOOD
MS
07906270
1326238171
CRENSHAW, GREGORY D MD
CELEVLAND
MS
00016891
1003803628
CRENSHAW, JR., ANDREW H MD
SOUTHAVEN
MS
04431059
1619262318
CRENSHAW, LAUREN T DMD
BRANDON
MS
01630559
1083729362
CRESWELL, LAWRENCE
JACKSON
MS
00655060
1154374957
CREWS, JAMES H MD
JACKSON
MS
07076260
1447279526
CRIDDLE III, FRANK J MD
TUPELO
MS
00880137
1659302735
CRIGLER, AMY A OD
STARKVILLE
MS
68
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03355367
1649635921
CRISTO, LOUISE NP
TUPELO
MS
00114642
1558475723
CRISWELL, BARBARA D
SUMNER
MS
00010920
1780687855
CRITTENDEN, JAMES C MD
BAY SAINT LOUIS
MS
00113884
1164465738
CRITTENDEN, MARCUS A MD
COLUMBUS
MS
04700246
1427044197
CROCKARELL JR, JOHN R MD
SOUTHAVEN
MS
05082097
1770519951
CROCKER JR, EDWARD F MD
COLUMBUS
MS
03338818
1982952115
CROCKER, JORDAN P DMD
MENDENHALL
MS
00015390
1770587388
CROCKETT, TERESA B FNP
BYHALIA
MS
00110973
1063498699
CRONE, ROBERT A
OLIVE BRANCH
MS
02334274
1225111073
CRONIN, CHRISTOPHER K DMD
HATTIESBURG
MS
09781823
1811926470
CROOK, LOUIE V MD
HATTIESBURG
MS
00111248
1598879314
CROOKS, WILLIAM P MD
POPLARVILLE
MS
08030571
1063440857
CROSBY, ROBERT L
MCCOMB
MS
00110316
1730197054
CROSBY, SAMUEL N MD
HATTIESBURG
MS
00126042
1447299508
CROSBY, STEPHANIE L WHNP
LAUREL
MS
06233378
1730552787
CROSS, ALEXIS L NP
GREENVILLE
MS
08674854
1699086918
CROSS, BRITTAIN DO
MORTON
MS
01309015
1770794695
CROSS, JOHN L MD
JACKSON
MS
00119948
1619919511
CROSSEN, KARL J MD
TUPELO
MS
03207030
1144486572
CROSSWHITE, RONALD B
TUPELO
MS
08605892
1952500373
CROTHERS, ANDREW W MD
SOUTHAVEN
MS
05953070
1992156434
CROTWELL, KATHERINE C NP
JACKSON
MS
04555046
1437115508
CROUCH, JAMES MD
OXFORD
MS
05234251
1083658488
CROUCH, MADISON S MD
MERIDIAN
MS
04505014
1871878967
CROUSE, GEORGE D NP
RIDGELAND
MS
00113871
1912007949
CROUT, JEFFREY D MD
JACKSON
MS
07781264
1033406525
CROUT, TERESA M MD
JACKSON
MS
08430344
1831446806
CROW, WHITNEY C CFNP
RULEVILLE
MS
69
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00114628
1053369801
CROWDER III, ROWE S MD
BAY ST LOUIS
MS
05787000
1114988086
CROWDER, JASON B MD
GULFPORT
MS
04580379
1689614240
CROWDER, KIMBERLY A MD
JACKSON
MS
03153889
1619919479
CROWDER, WILLIAM H MD
JACKSON
MS
00028059
1114280591
CROWELL, RASHEEDA D
HATTIESBURG
MS
00116236
1699718700
CROWELL, WEYMOTH MD
SAUCIER
MS
00111249
1407830433
CROWLEY, SHEILA W MD
MISSISSIPPI STATE
MS
06788527
1912129826
CROWSON, THOMAS D MD
MERIDIAN
MS
04180352
1639197494
CROWTHER, MARSHALL J
UNIVERSITY
MS
00120141
1609996982
CRUEL, LARRY K DPM
BRANDON
MS
04952378
1104208651
CRUISE, CARSON DMD
JACKSON
MS
00123523
1588674816
CRUISE, CINDY N FNP
FLOWOOD
MS
00121751
1225118441
CRUMP, DAVID B
LUCEDALE
MS
00016859
1841344892
CRUMP, NORRIS V MD
TUPELO
MS
09306761
1588084198
CRUSE, ALLISON R MD
JACKSON
MS
00805595
1154381200
CRUTCHFIELD, SYLVIA D
ITTA BENA
MS
02588212
1316108756
CRUZ, MARISSA O DO
CORINTH
MS
05877267
1407015001
CUELLAR, TRAJAN A MD
JACKSON
MS
00124120
1477628063
CUEVAS, THERESA L CFNP
GULFPORT
MS
01037793
1063645166
CULLEN, MICHELLE FNP
OXFORD
MS
07330559
1821365511
CULLIVER, STELLA S NP
WHITFIELD
MS
05883835
1710997135
CULLOM III, EDWARD T M.D.
FLOWOOD
MS
01381553
1396951620
CULNAN, DEREK M MD
JACKSON
MS
07684856
1598077059
CULPEPPER, GREGORY R MD
PASCAGOULA
MS
01809068
1033346168
CULPEPPER, JAY M MD
GREENWOOD
MS
02437260
1376096826
CULPEPPER, MELISSA E NP
JACKSON
MS
00121407
1598864274
CULPEPPER, ROBERT B MD
GULFPORT
MS
02609314
1396018123
CUMBERLAND, TERESA K FNP
CHOCTAW
MS
70
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01783067
1679777585
CUMBIE, TODD A MD
JACKSON
MS
00019926
1972501815
CUMMINGS III, JOHNNIE E MD
CLARKSDALE
MS
00123837
1578599395
CUMMINGS, BETSY J CFNP
GREENVILLE
MS
01875551
1427145002
CUMMINS, ERIN R MD
JACKSON
MS
00060059
1952436859
CUMMINS, JAMES R DMD
CORINTH
MS
03083366
1558709543
CUMMINS, JAMIE T DMD
LAUREL
MS
00959245
1760663579
CUNNINGHAM, AMANDA R MD
SOUTHAVEN
MS
00012390
1407832041
CUNNINGHAM, EDWIN D
OLIVE BRANCH
MS
00709514
1922069715
CUNNINGHAM, GARVIN W DMD
GULFPORT
MS
02131859
1790125110
CUNNINGHAM, JAMES A MD
JACKSON
MS
09123759
1073798781
CUNNINGHAM, JEFFREY J MD
SOUTHAVEN
MS
00016395
1245309418
CUNNINGHAM, JERRY M MD
GREENVILLE
MS
08806571
1821219106
CUNNINGHAM, MICHAEL C MD
BILOXI
MS
09282811
1336140078
CUNNINGHAM, STEVEN G MD
HATTIESBURG
MS
00083251
1730133828
CUNNINGHAM, SUSANNE S OD
COLUMBUS
MS
07772764
1811372428
CUNNINGHAM, VIRGINIA K NP
JACKSON
MS
00122908
1235171265
CUPP, CATHERINE N MD
GULFPORT
MS
01023864
1902146624
CURBOW, CHRISTIANNE FNP
SOUTHAVEN
MS
08605767
1649478264
CURLEY, ELIZABETH D MD
JACKSON
MS
03977505
1255669875
CURLEY, MEREDITH B FNP
JACKSON
MS
00123917
1922147123
CURRIE, LYNNE C FNP
JACKSON
MS
00124472
1740359892
CURRY, GENEVA CFNP
GREENVILLE
MS
00114262
1295772218
CURRY, PATTI H CFNP
WOODVILLE
MS
00123673
1013050384
CURRY, ROBERT H MD
JACKSON
MS
00126898
1760587778
CURRY, ROBERT L MD
GREENVILLE
MS
06557771
1023496650
CURTI, STEVEN A MD
JACKSON
MS
00382724
1487939435
CURTIS JR, DAVID K DMD
COLUMBUS
MS
00880218
1518917053
CURTIS, DAVID H
COLUMBUS
MS
71
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00060291
1538223052
CURTIS, DAVID K MD
COLUMBUS
MS
06906031
1740484302
CUSHING, CAROLYN A MD
JACKSON
MS
05189785
1912007881
CUSICK III, HOWARD T MD
MERIDIAN
MS
04871042
1396062030
CUSIMANO, III, LUKE A MD
JACKSON
MS
02488769
1700240843
CUTRER, RALEIGH C MD
JACKSON
MS
06759064
1063528750
DABBS JR, WILLIS N MD
OXFORD
MS
00125827
1871538652
DABBS, ANDREW P MD
PHILADELPHIA
MS
01687220
1689950040
DABBS, LISA G CANP
TUPELO
MS
00116608
1972558500
DABDOUB, WILLIAM H DPM
PICAYUNE
MS
00122613
1699761387
DABOV, GREGORY D MD
SOUTHAVEN
MS
01787767
1952533697
DADI, NEELAKANTA A MD
JACKSON
MS
00015608
1003908476
DAHL, ERIC P DO
OXFORD
MS
06680271
1881803013
DAHO, JOSEPH J DDS
PICAYUNE
MS
06132001
1982719811
DAHO-HABEEB, AMANDA E
HATTIESBURG
MS
04208323
1851689897
DAHSE, MELANIE C MD
JACKSON
MS
09687289
1851755870
DAIGLE, CRYSTAL E MD
JACKSON
MS
06239077
1376566869
DAIGLE, DONIELLE A MD
GULFPORT
MS
02052300
1487686374
DAILY, PATRICK P MD
JACKSON
MS
09008865
1013967835
DALATI, FAKHRI MD
HATTIESBURG
MS
00111462
1215041652
DALE JR, ROBERT A MD
MANTACHIE
MS
00358088
1366498677
DALES, LINDA M MD
MERIDIAN
MS
08079861
1770529802
DALEY, WILLIAM P MD
JACKSON
MS
06407309
1740361930
DALLMAN, MICHAEL D MD
JACKSON
MS
03057071
1306226865
DALTON, CELENA A NP
MCCOMB
MS
00116472
1801837679
DALY, EDWARD F MD
NATCHEZ
MS
00116647
1447316732
DALY, JOHN S MD
JACKSON
MS
09035591
1861488215
DAMALLIE, KUSHNA K MD
CLARKSDALE
MS
07484021
1982062170
DAMICO, JAMIE NP
OCEAN SPRINGS
MS
72
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08438356
1700020591
DAMICO, KAREN M MD
SOUTHAVEN
MS
00880098
1649327545
DAMPIER JR, ARTHUR R OD
RIDGELAND
MS
02756524
1346291432
DANA NASH
BYHALIA
MS
00122374
1477561728
DANFORD, JOSEPH R MD
ELLISVILLE
MS
00122376
1205844560
DANFORD, OMELIA E MD
ELLISVILLE
MS
01303309
1760802771
DANG, KEVIN MD
JACKSON
MS
05286852
1093072985
DANIEL, BRITTANY A FNP
JACKSON
MS
00019627
1639104904
DANIEL, III, CARLTON R MD
JACKSON
MS
08603863
1013228329
DANIELS, JUSTIN B MD
MERIDIAN
MS
00125003
1104869353
DANIELSON, DIRK MD
JACKSON
MS
00118174
1396846333
DAOUD, RAOUF F
JACKSON
MS
05305527
1174728299
DAPHNIS, JONEL MD
JACKSON
MS
04688800
1518270636
DAR, MADIHA MD
SOUTHAVEN
MS
03872801
1255698247
DARAY, ROSS D MD
MCCOMB
MS
05983278
1891970521
DARBY, MARIE M MD
HATTIESBURG
MS
02157599
1649470147
DARBY, NATHAN C MD
HATTIESBURG
MS
09384306
1821248527
DARBY, NICHOLAS M DDS
RICHTON
MS
02707554
1730592296
DARBY, SHELLEY E FNP
PHILADELPHIA
MS
00019377
1396773941
DARE, DANIEL MD
VICKSBURG
MS
00486201
1073724910
DARE, PAUL MD
JACKSON
MS
05108551
1205027489
DARG-QUINONES, RUTH G MD
NATCHEZ
MS
03533776
1285855973
DARIN, MICHAEL E MD
OCEAN SPRINGS
MS
08087069
1245437789
DARKO, LETICIA O MD
JACKSON
MS
00119709
1114083490
DARLING, BRYAN K
TUPELO
MS
06934511
1780667188
DARRELL G CROFT DPM
OXFORD
MS
04850575
1689961914
DARSEY III, WILLIAM S MD
TUPELO
MS
04756525
1730491556
DARSEY, DAMON A MD
MERIDIAN
MS
00123657
1851396337
DARSEY, KENT A MD
MERIDIAN
MS
73
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00223242
1295974483
DASTOURI, POUYA MD MP
PICAYUNE
MS
09102212
1568468908
DAUD, ZAINEB MD
MERIDIAN
MS
02638065
1417297342
DAUENHAUER, JULIA NP
BAY ST LOUIS
MS
04475520
1902814361
DAUGHTREY, KENNETH R MD
SEMINARY
MS
04475520
1902814361
DAUGHTREY, KENNETH R MD
BRANDON
MS
05620070
1962866004
DAUPHIN, PATRICK D MD
JACKSON
MS
05308319
1851421192
DAURO, ANGELA M PA-C
OCEAN SPRINGS
MS
00117914
1558491589
DAUTERIVE, ALTON H MD
GULFPORT
MS
03102071
1487018420
DAUTERIVE, ELLEN MD
JACKSON
MS
07153065
1174714299
DAVE, BHAVIKA R MD
JACKSON
MS
09076312
1669665881
DAVE, NINABAHEN D MBBS
JACKSON
MS
00115846
1851373674
DAVENPORT, JR., CHARLES W
MERIDIAN
MS
03809561
1275973067
DAVES, JESSICA L DDS
HORN LAKE
MS
00116508
1912934126
DAVEY-SULLIVAN, BARBIE J MD
JACKSON
MS
02651222
1639519903
DAVIDSON, CASEY T MD
JACKSON
MS
09789859
1801277959
DAVIDSON, JAMES R
TUPELO
MS
06772519
1780949503
DAVIDSON, JAMIE V FNP
JACKSON
MS
05878553
1518113166
DAVIDSON, KAREN CFNP
FOREST
MS
04084377
1245521665
DAVIDSON, SHEILA D CFNP
MERIDIAN
MS
00119731
1851323687
DAVIDSON, STEPHEN F MD
FLOWOOD
MS
08470589
1508806308
DAVIDSON, SUEANNE M DNP
COLUMBUS
MS
03122859
1003006206
DAVIS II, LAMAR MD
JACKSON
MS
08555560
1053703132
DAVIS, AMMY H NP
JACKSON
MS
08033823
1184755308
DAVIS, AMY B MD
TUPELO
MS
01524745
1750438255
DAVIS, ANDREA L DDS
GULFPORT
MS
01872256
1588991731
DAVIS, ASHLEY T FNP
LOUISVILLE
MS
04902336
1033592985
DAVIS, AUBREE J FNP-C
FLORENCE
MS
03183371
1235343187
DAVIS, BRANDON L MD
GULFPORT
MS
74
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00123809
1932103546
DAVIS, BRENDA L FNP
BYHALIA
MS
02155395
1063662419
DAVIS, CHRISTY NP
JACKSON
MS
01802226
1083647960
DAVIS, CLIFTON H PA
HATTIESBURG
MS
03975323
1366749707
DAVIS, DAREL L FNP
OLIVE BRANCH
MS
02386374
1366880015
DAVIS, DARON D MD
VICKSBURG
MS
02170804
1174567580
DAVIS, DERECK MD
JACKSON
MS
00880157
1558379206
DAVIS, EDWARD W OD
LAUREL
MS
09329543
1598052094
DAVIS, ERIC D MD
JACKSON
MS
08025804
1821302795
DAVIS, EVAN W DO
LAUREL
MS
00115962
1912065251
DAVIS, GARY M MD
JACKSON
MS
05809761
1700041308
DAVIS, GEORGE V MD
GAUTIER
MS
00126895
1083660732
DAVIS, IV, JOHN D MD
FLOWOOD
MS
00728053
1770877623
DAVIS, JAWANNER L MSN
JACKSON
MS
08238738
1659755429
DAVIS, JAZMINE J NP
JACKSON
MS
03484830
1699151464
DAVIS, JESSICA M NP
JACKSON
MS
00303529
1942505706
DAVIS, JORRI S MSN
CANTON
MS
02683804
1629282496
DAVIS, JUSTIN R MD
JACKSON
MS
09200561
1528276722
DAVIS, KASEY I MD
JACKSON
MS
01631247
1699226399
DAVIS, KIMBERLY F FNP-C
FLOWOOD
MS
02873722
1063706802
DAVIS, LAMONICA I DMD
JACKSON
MS
04832311
1619226032
DAVIS, LAURA NP
BATESVILLE
MS
05584391
1033361233
DAVIS, LELOUISE T FNP
JACKSON
MS
00116318
1033147442
DAVIS, MICHAEL L MD
VICKSBURG
MS
00116791
1043292931
DAVIS, RHONDA P NP
NEWTON
MS
00110269
1255351367
DAVIS, RONALD D MD
JACKSON
MS
02183007
1447405998
DAVIS, SCOTT A MD
BYRAM
MS
00454300
1013384577
DAVIS, SHEILA P FNP-C
BYRAM
MS
05402860
1568836815
DAVIS, SHELBY P NP
JACKSON
MS
75
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07809841
1699177634
DAVIS, SHONNA NP
BRANDON
MS
01620736
1912273814
DAVIS, STANITIA W DPM
JACKSON
MS
01226866
1902212871
DAVIS, SUSAN M NP
MERIDIAN
MS
06074350
1184081234
DAVIS, TAMMY S PA
JACKSON
MS
01888853
1760568398
DAVIS, TEARSANEE G APRN
JACKSON
MS
06700861
1619377199
DAVIS, TIMOTHY G CNP
HORN LAKE
MS
00906292
1104879329
DAVIS, VANESSA A APN
SOUTHAVEN
MS
00087007
1063482453
DAVIS, WILLIAM G OD
NEWTON
MS
00014052
1225017668
DAVIS, WILLIAM L MD
STARKVILLE
MS
05602851
1407237365
DAVIS, WILLIAM P
TUPELO
MS
00112110
1912104159
DAVIS-SULLIVAN, HURSIE J MD
JACKSON
MS
04558008
1760653034
DAWKINS JR, WARD E DDS
OXFORD
MS
07184278
1851611768
DAWKINS, BRYAN M MD
PICAYUNE
MS
00010387
1124026034
DAWKINS, CRAIG A MD
GULFPORT
MS
05728359
1356531263
DAWKINS, HENRY L ACNP
MCCOMB
MS
08229286
1912012121
DAWKINS, PAULETTE G CFNP
GULFPORT
MS
04153252
1568759165
DAWSON, BRANDON W MD
JACKSON
MS
04952816
1033404538
DAWSON, ELIZABETH B CFNP
INDIANOLA
MS
08431337
1134416894
DAWSON, HOLLY M MD
JACKSON
MS
07950316
1710959283
DAWSON, JENNIFER S
IUKA
MS
00933806
1861801631
DAWSON, JOHN B OD
MADISON
MS
03820742
1467861484
DAWSON, JULIE B OD
MADISON
MS
02080388
1306195565
DAWSON, MAGGIE A FNP
MORTON
MS
07139787
1275944118
DAWSON, SARA K MD
JACKSON
MS
00112750
1275695694
DAYTON, HARRY E MD
MERIDIAN
MS
00124990
1275539017
DE ASIS, BENARD G MD
LAUREL
MS
00507093
1043294432
DE DELVA, PIERRE E MD
JACKSON
MS
00018389
1003826272
DEAL, JO P MD
JACKSON
MS
76
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03033749
1144462300
DEAN, DAVID MD
TUPELO
MS
00120974
1114976677
DEAN, DAVID A DO
BROOKHAVEN
MS
07836552
1407255425
DEAN, JOSHUA S FNP
MERIDIAN
MS
03353859
1881063444
DEAN, KAYLA R NP
JACKSON
MS
01688010
1093912826
DEAN, MALCOLM S MD
GULFPORT
MS
00123534
1528060522
DEAN, ROBERT L MD
MERIDIAN
MS
03271232
1851655310
DEAR, JENNA L MD
JACKSON
MS
01922773
1922457266
DEARMAN, BARBIE M FNP
HATTIESBURG
MS
08988022
1407206139
DEARMAN, TIFFANY R FNP
MERIDIAN
MS
00656040
1700051281
DEARMOND, DAWN NNP
JACKSON
MS
01477212
1942609664
DEBAR, KELLEY E CFNP
LUCEDALE
MS
01930561
1790827335
DEBEN, FREDERICK J CFNP
PICAYUNE
MS
01003838
1750351540
DECANTER, PAULA J CFNP
TUPELO
MS
08251044
1679734933
DECKER, CHRISTOPHER H MD
TUPELO
MS
00012512
1487662763
DECOUX JR, ROBERT E MD
MCCOMB
MS
00120206
1639171234
DEDEAUX, WANDA J FNP
PASCAGOULA
MS
08782051
1457393183
DEDMON, DIANA D FNP
SOUTHAVEN
MS
06036854
1578528188
DEDWYLDER, REBEKAH M PA
SOUTHAVEN
MS
00931861
1568816221
DEES, ASHLEY S MSN
JACKSON
MS
00125160
1962440115
DEES, JASON B DO
NEW ALBANY
MS
05280351
1366523748
DEES, STRAWFORD MD
OCEAN SPRINGS
MS
00115376
1265480156
DEESE, LAWRENCE E MD
OXFORD
MS
DEFAULT PROVIDER-VOID VOID
RIDGELAND
MS
00019999
Jun 11, 2017
08872851
1437694320
DEGELMAN, KRISTEN NP-C
JACKSON
MS
09379575
1922037118
DEGLER, SHAWN MD
JACKSON
MS
01337059
1528471091
DEGROAT, CHRISTOPHER MD
JACKSON
MS
00121974
1649365396
DEGROOTE, JOHN W MD
PASCAGOULA
MS
05951803
1356566525
DEISSEROTH, KATE B MD
TUPELO
MS
77
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118247
1609945716
DEL CASTILLO-ARCEO, KATHERYN
CARTHAGE
MS
08856014
1982715454
DELANEY, LESLIE B M.D.
MADISON
MS
05050254
1821537200
DELANEY-DAVIS, JENNIFER NP
OCEAN SPRINGS
MS
08829754
1710309877
DELANEY-MAGITT, ROSELYN FNP
ROBINSONVILLE
MS
00015359
1538104757
DELASHMET, GORDON B MD
JACKSON
MS
01726582
1467753772
DELASKI, DANA M FNP-C
JACKSON
MS
00122444
1568438117
DELGADO, NESTOR K MD
PASCAGOULA
MS
00660307
1215906573
DELLINGER, TRACY M
JACKSON
MS
00113804
1679681894
DELOACH, MARK A MD
LAUREL
MS
06781039
1184053159
DELVA, GEUKA MD
JACKSON
MS
00123535
1619918521
DEMENT, LISA A FNP
COLUMBUS
MS
00887242
1861842478
DEMETROPOULOS, ARIANA L DMD
NETTLETON
MS
00014926
1932259546
DEMETROPOULOS, STEVEN L
PASCAGOULA
MS
07376818
1154401909
DEMING, FANASY P DMD
JACKSON
MS
03470368
1548654098
DEMOSS, PATRICK J MD
JACKSON
MS
07602854
1871637264
DENISON, DANIEL D MD
MERIDIAN
MS
09652019
1427349273
DENIUS, MARY E NP
PETAL
MS
03859527
1831534718
DENLEY-HUMBER, PAMELA L NP
SOUTHAVEN
MS
03625746
1316270762
DENMARK, CYNTHIA W FNP
LEAKESVILLE
MS
00114295
1881696862
DENNEY, DELORA A MD
PICAYUNE
MS
00122972
1427050418
DENNEY, JAMES L FNP
PICAYUNE
MS
04437250
1336224526
DENNEY, SAM J MD
FLOWOOD
MS
00122405
1477614402
DENNIS, DAVID M MD
OXFORD
MS
00126004
1386750909
DENNIS, JEFFREY W MD
OXFORD
MS
00112220
1760466262
DENNIS, LAURENCE L MD
BOONEVILLE
MS
05179540
1225115918
DENNIS, WILEY S MD
PASCAGOULA
MS
07576837
1770028441
DENSON, RACOLESHA R FNP-C
JACKSON
MS
02489587
1447327838
DENTAL CONCEPTS
BILOXI
MS
78
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07975768
1669850293
DEPAEPE, STEPHANIE K DO
JACKSON
MS
00638852
1487834206
DEPAULO, SUZANNE MD
COLUMBUS
MS
00087923
1801964259
DEPRIEST, STEVE M OD
OXFORD
MS
00523070
1841612066
DEPTA, AMY NP
NATCHEZ
MS
00116735
1215945506
DERHGAWEN, SANJAY MD
HATTIESBURG
MS
05202869
1962885483
DERIVAUX SMITH, KATHRYN DDS
HORN LAKE
MS
01536317
1487683991
DERR, DAVID R MD
RIDGELAND
MS
07984875
1396980009
DERRYBERRY, JOSHUA T
HATTIESBURG
MS
00118384
1689674707
DERVELOY III, ROBERT J MD
TUPELO
MS
00882811
1932446218
DESAI, JAGDISH B MD
JACKSON
MS
04880512
1578505715
DESAI, KIRTIDA D MD
WHITFIELD
MS
05907072
1164601761
DESAI, PARAG MD
COLUMBIA
MS
09923018
1457618829
DESAI, SIDDHARTH N MD
JACKSON
MS
00119497
1053350223
DESANTIS, ROBERT A MD
LAUREL
MS
00118453
1316983943
DESCHER, WILLIAM C
OCEAN SPRINGS
MS
00277253
1518178441
DESHAZO, MATTHEW D MD
JACKSON
MS
06552708
1477872554
DESHAZO, MEGAN E MD
JACKSON
MS
00019701
1225072838
DESHAZO, RICHARD D
JACKSON
MS
09173297
1861411084
DESHIELDS III, LAURENCE M MD
VICKSBURG
MS
02277763
1770536229
DESSE, JEAN MD
JACKSON
MS
06082536
1720276009
DEVALL, TERRY M DMD
TUPELO
MS
05384872
1174070684
DEVAUGHN, MALORIE P ACNP
CORINTH
MS
03235798
1710906268
DEVELIN, DEBRA M NP
PUCKETT
MS
02259291
1376620906
DEVEREUX, JACK P
CARRIERE
MS
04170832
1750492609
DEVILLIER, ALBERT B MD
HATTIESBURG
MS
07984848
1134178262
DEVLIN-SCHROLL, CHRISTIE MD
LONG BEACH
MS
00660289
1861629974
DEW, CARROLL W DDS
JACKSON
MS
07408034
1134243702
DEW, JAMES M MD
JACKSON
MS
79
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04501384
1265622971
DEW, TARA L OD
KOSCIUSKO
MS
09277824
1952656183
DEWEY, KELLY J DO
GULFPORT
MS
09688518
1508942137
DEWITT, ERIN A MD
WIGGINS
MS
00474860
1023009263
DEWITT, ROBERT C MD
MCCOMB
MS
06583259
1194926766
DEWS, ROBERT C MD
HATTIESBURG
MS
00122340
1740251941
DEY, JAYANT MD
TUPELO
MS
00124063
1689731606
DEYLAMIPOUR, SHAHZAD MD
BELZONI
MS
03900372
1841223377
DHAR, UJJWAL MD
JACKSON
MS
07179335
1487836060
DHARMAPURI, SADHANA K MD
JACKSON
MS
09508353
1154733079
DHILLON, SARA MD
JACKSON
MS
00124717
1760426134
DHOSSCHE, DIRK M MD
JACKSON
MS
00480330
1801989439
DIAL, CHRISTINA L DO
FLOWOOD
MS
04054008
1790719250
DIAL, JUDITH M
JACKSON
MS
00125973
1124023098
DIAMOND, CHAD J DO
HATTIESBURG
MS
00015105
1124032644
DIAZ, ALBERT L MD
OCEAN SPRINGS
MS
00115062
1780685578
DIAZ, MICHAEL J MD
GULFPORT
MS
01220773
1073975017
DIBBLE, JOSHUA E DO
JACKSON
MS
01457857
1104139450
DICICCO, ERICA A DO
OXFORD
MS
02952514
1649695644
DICKARD, SHONNA B NP
OXFORD
MS
00121876
1770552135
DICKENS, MARTHA D MD
JACKSON
MS
07703391
1265818033
DICKERSON, EMILY S NP
JACKSON
MS
08921721
1699777854
DICKERSON, GREGG MD
GREENVILLE
MS
06626200
1295926384
DICKERSON, MICHELLE L NP
WHITFIELD
MS
00014082
1942243712
DICKERSON, QUINTON H MD
JACKSON
MS
05739790
1396832309
DICKEY, DANNY H DDS
TUPELO
MS
01839260
1174691216
DICKSON, JOHN A MD
MERIDIAN
MS
02355568
1720499825
DIDDI, VENKATA D MD
JACKSON
MS
01375274
1619186541
DIDION, LISA A MD
JACKSON
MS
80
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00121615
1144233974
DIEDRICHSEN, SHARON E CNM
GULFPORT
MS
00660259
1689728362
DIGBY, JASON L DMD
FULTON
MS
01055392
1841490422
DIGBY, MYLES C MD
PICAYUNE
MS
08259244
1336531672
DILL, LYNDSEY T ACNP
JACKSON
MS
00839845
1639106636
DILLARD, BENJAMIN C
JACKSON
MS
00121451
1699775171
DILLON JR, ALVA
OCEAN SPRINGS
MS
01324359
1861862963
DILLON, ASHLEY N NP-C
GLOSTER
MS
05128331
1609163062
DILLON, DANETT A MD
JACKSON
MS
09876786
1134238322
DILLON, LANCE DMD
JACKSON
MS
00120305
1811030091
DILLON, PAMELA A NP
TYLERTOWN
MS
09001098
1992939490
DILTS, BRENT MD
GULFPORT
MS
00015013
1639205610
DILWORTH, ROBERT E MD
MERIDIAN
MS
09182377
1396065694
DIMITRIADES, AMY M NP
GULFPORT
MS
00119666
1851327522
DIMITRIADES, DIMITRIOS MD
GULFPORT
MS
03626501
1699062208
DINNING, JENNIFER R MD
JACKSON
MS
05650271
1851324784
DIPAOLO, DANECA M MD
GRENADA
MS
06583205
1245426998
DIRMEYER, STEVEN N
PONTOTOC
MS
06920300
1679564264
DIVITTORIO, ROY MD
PICAYUNE
MS
00113498
1932215464
DIX, BRIAN R DO
GULFPORT
MS
03524741
1821452863
DIXIT, CHESHIL MD
JACKSON
MS
03786863
1588110878
DIXIT, DEVON R OD
CLINTON
MS
07933347
1558397299
DIXIT, MEHUL P MBBS
JACKSON
MS
09632891
1972515930
DIXIT, NAZNIN M MBBS
JACKSON
MS
00125091
1760459242
DIXIT, PRASHANT P
GULFPORT
MS
07882782
1902914716
DIXON, BERNADINE C APRN
TUPELO
MS
00064632
1669617932
DIXON, BRUCE H DDS
HATTIESBURG
MS
00620761
1922422583
DIXON, JENNA L PA
TUPELO
MS
06432315
1114396553
DIXON, LAURA M DMD
RALEIGH
MS
81
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00836029
1912268350
DIXON, MADINA C NP
MADISON
MS
04572852
1689014037
DIXON, PHILLIP A MD
JACKSON
MS
00660391
1770600819
DIXON, STEPHEN T
HATTIESBURG
MS
05275295
1255593364
DIXON, TAMMY L NP
BROOKHAVEN
MS
00117256
1427262591
DIXON, WILLIAM N MD
MCCOMB
MS
02439227
1588004774
DO, LINDA MD
JACKSON
MS
00060338
1316036395
DOBBS, JIMMY G DMD
CALHOUN CITY
MS
00124553
1265456818
DOBBS, KIMBERLY G MD
LAUREL
MS
01975826
1295099455
DOBBS, SHANNON DO
FOREST
MS
00124354
1770597882
DOBBS, THOMAS E
LAUREL
MS
00660085
1598849291
DOCKINS, JOANDREA T DDS
JACKSON
MS
09150271
1336403716
DODD, ERIN E MD
JACKSON
MS
00087924
1326121336
DODD, JOHN D O.D.
CORINTH
MS
00018622
1619020401
DODD, JOHN E MD
JACKSON
MS
08581575
1063727535
DODD, NIXON D OD
CORINTH
MS
05957764
1134462849
DODGE, ALI MD
JACKSON
MS
06636767
1366845307
DODGE-KHATAMI, JANNIKA MD
JACKSON
MS
00117318
1770568230
DODSON, MELISSA C FNP
MS STATE
MS
04884368
1285729020
DOFF, MICHAEL D MD
WINONA
MS
08385865
1295120137
DOGGETTE, ROBERT P MD
JACKSON
MS
03837264
1396088209
DOHERTY, JOSEPH E MD
JACKSON
MS
00119624
1720011695
DOHERTY, MICHAEL MD
JACKSON
MS
00880068
1780674317
DOHERTY, PATRICK R OD
NATCHEZ
MS
00880060
1043200553
DOHERTY, SHAWN P OD
NATCHEZ
MS
01134026
1437562980
DOLIA, JAYDEV N MD
JACKSON
MS
00118493
1124193529
DOLLAR, CAROLYN E FNP
NATCHEZ
MS
02908859
1770996050
DOMINIQUE, OMAR L MD
JACKSON
MS
07687226
1962603886
DOMKAM, ALAIN L MD
GREENWOOD
MS
82
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00114781
1578654125
DONAHOE, JR., EDGAR N MD
INDIANOLA
MS
04804742
1972841419
DONAHUE, PATRICIA E PA
OLIVE BRANCH
MS
02232066
1013005040
DONALD III, WILLIAM D MD
HATTIESBURG
MS
00114734
1770585630
DONALD, III, ROBERT L MD
PASCAGOULA
MS
00060320
1811105984
DONALD, W. MARK
LOUISVILLE
MS
08403201
1710945860
DONATO, ROBERT A MD
SOUTHHAVEN
MS
05957593
1326343484
DONEGAN, KELLI M NP
BILOXI
MS
00119509
1669543120
DONELSON, SHIRLEY S MD
FLOWOOD
MS
07824302
1477829315
DONKOR, ERNEST A MBCHB
DEKALB
MS
05001054
1639114218
DONOHUE, CARY T DPM
PICAYUNE
MS
00115163
1093888661
DONOHUE, DIANE M MD
OLIVE BRANCH
MS
00138046
1750736898
DOO, CAROLINE MD
JACKSON
MS
01533818
1568792885
DOOLITTLE, CAROL C FNP
GREENVILLE
MS
03507846
1932252954
DOOLITTLE, JEFFERY S MD
GREENVILLE
MS
00115158
1104925148
DOOLITTLE, PHILIP D
GREENVILLE
MS
00118679
1518906734
DORAN JR, DONALD R DO
WIGGINS
MS
06124867
1356414908
DORCIK, MICHAEL D DO
BILOXI
MS
00126824
1588609960
DORIN, SCOTT E MD
CORINTH
MS
00126576
1932156163
DOROUGH, REBECCA R FNP
TUPELO
MS
01953308
1447527486
DORRIS, SHANNON L FNP
WHITFIELD
MS
00122683
1942538459
DORRITY, MICHAEL A MD
SOUTHAVEN
MS
08156332
1447677836
DORSEY, TERRY A CNP
GREENVILLE
MS
01033519
1295144178
DOS SANTOS E. SANTOS, CHRISTIANO MD
JACKSON
MS
00114712
1831150531
DOSHI, HARSH
LEXINGTON
MS
03934552
1487834818
DOSS, NORRIS N CFNP
SHANNON
MS
00115655
1346238615
DOTHEROW, PIERCE D MD
FLOWOOD
MS
02775800
1720057565
DOTSON, CYNTHIA C NP
HOLCOMB
MS
00123229
1205935269
DOTSON, RENIA R
GREENVILLE
MS
83
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00123301
1184684375
DOTSON, WAYNE A
GREENVILLE
MS
00660144
1790851707
DOTY JR, RAYMOND K
GULFPORT
MS
02727709
1457398729
DOTY, MOLLIE M CFNP
JACKSON
MS
00125976
1477679736
DOUG BYRD MD PLLC
JACKSON
MS
00010630
1023043221
DOUGLAS III, JOHN H
TUPELO
MS
04635505
1932309648
DOUGLAS ORTHODONTICS
MERIDIAN
MS
00054336
1497195747
DOUGLAS, CANDACE L MD
JACKSON
MS
08755294
1427251511
DOUGLAS, CHRISTOPHER J MD
HATTIESBURG
MS
07953363
1477933745
DOUGLAS, GARRETT L FNP
FOXWORTH
MS
05038051
1194188722
DOUGLAS, JESSICA L MD
JACKSON
MS
09207321
1730566175
DOUGLAS, JOHN M NP-C
LIBERTY
MS
00019714
1972530335
DOUGLAS, JOHN W M.D.
GULFPORT
MS
00324314
1013173590
DOUGLAS, LAURIE E MD
HATTIESBURG
MS
08006553
1659571438
DOUGLAS, PHILLIP E DO
TUPELO
MS
04050006
1306038849
DOUTHITT, LUKE M MD
OLIVE BRANCH
MS
00115858
1942384300
DOWDY, HARRY L MD
YAZOO CITY
MS
06570707
1023079068
DOWDY, HEATHER M OD
SOUTHAVEN
MS
00114780
1841285764
DOWELL, WILLIAM W MD
INDIANOLA
MS
04533319
1467758573
DOWNARD, AMANDA L FNP
WHITFIELD
MS
00118867
1740240944
DOWNS, ALIENE NP
GREENWOOD
MS
08687561
1598107146
DOWNS, AMY L DMD
BOONEVILLE
MS
00660162
1740388446
DOWNS, LARRY C DDS
BOONEVILLE
MS
01125573
1154324895
DOX, HECTOR A MD
COLUMBUS
MS
02286218
1063692770
DOYLE, ALLISON H DO
CLEVELAND
MS
06184228
1285725838
DOZIER, JENNIFER Y CFNP
COLUMBUS
MS
00123552
1114925534
DOZIER, TIMOTHY J M.D.
PICAYUNE
MS
00126282
1013064245
DRACE, LEIGH P NP
SAUCIER
MS
02872253
1790717601
DRAGON, DAVID M MD
WOODVILLE
MS
84
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04288876
1144518788
DRAHUSCHAK, NICOLE F CNP
JACKSON
MS
00117280
1154349223
DRAKE, JOHN K MD
VANCLEAVE
MS
02331347
1346257771
DRAKE, SABRA F MD
SOUTHAVEN
MS
09582002
1871849372
DRAMBAREAN, LAVINIA D PA
HATTIESBURG
MS
03373059
1033344734
DRAMBAREAN, PAUL MD
HATTIESBURG
MS
03029221
1164746939
DRANE, KENNETH S MD
NATCHEZ
MS
01526357
1194047829
DRANE, LUCINDA B FNP
NATCHEZ
MS
00122270
1144363987
DRAPER, THOMAS
IUKA
MS
00660401
1841301314
DRAPER, VIVIAN DDS
SMITHVILLE
MS
00123182
1144257460
DREISBACH III, ALBERT W M.D.
JACKSON
MS
06208260
1285601856
DREYER, KRISTI L DO
COLUMBUS
MS
06608851
1932413762
DRIGGERS, BENDAN B FNP
LAUREL
MS
06250099
1013985225
DRIGGERS, HANNAH J NP
TUPELO
MS
00189001
1326197732
DRIVER, KARA N MD
JACKSON
MS
02358847
1992194955
DRIVER, WAYNE J NP
GULFPORT
MS
02980031
1972910230
DRUMMOND, ELIZABETH C NP
GULFPORT
MS
00660370
1134250855
DRUMMOND, JAMES J DMD
MERIDIAN
MS
00123549
1134250855
DRUMMOND, JAMES J MD
MERIDIAN
MS
02654890
1558382358
DUBARD, LILLIAN L NPC
GRENADA
MS
04786231
1851832828
DUBARD, SARAH A NP
CANTON
MS
03388585
1619274032
DUBOSE, SUSAN L NP
HATTIESBURG
MS
06052006
1669753927
DUCKSWORTH, MONET K DMD
HATTIESBURG
MS
00121379
1083682934
DUCKWORTH, MICHAEL R MD
COLUMBUS
MS
06633737
1972916633
DUCKWORTH, SAVANNAH MD
JACKSON
MS
00015358
1003840539
DUDDLESTON, DAVID N MD
JACKSON
MS
00121114
1124234307
DUDLEY, PATRICIA L MD
GREENVILLE
MS
04308213
1386038651
DUFF, JOEL D MD
JACKSON
MS
00116211
1750310066
DUFF, KENNETH E MD
HATTIESBURG
MS
85
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00115105
1346377769
DUFF, REBECCA R MD
PETAL
MS
00123240
1871674713
DUFFIE-MORGAN, SUSAN
MANTACHIE
MS
00121060
1922166867
DUFFIELD, DERRICK R
RICHTON
MS
00019281
1588650329
DUFFY, PATRICK A
NATCHEZ
MS
05370501
1245292515
DUGAN, VERONICA T MD
PICAYUNE
MS
05088262
1831555002
DUGAS, ANNELLE C CNP
HATTIESBURG
MS
00014341
1003893652
DUGGAN, FREDERICK T
MERIDIAN
MS
00116232
1255416822
DUGGER, DAVID L MD
OCEAN SPRINGS
MS
06453568
1457615601
DUKE, JUSTIN C DO
TUPELO
MS
04856867
1184058836
DUKE, LORI S FNP
RIPLEY
MS
03285702
1942747266
DUKE, MAGGIE E NP
PASCAGOULA
MS
00124254
1124090618
DUKES, ERIK W MD
BOONEVILLE
MS
00118075
1922029750
DUKES, FRANCES D
JACKSON
MS
09555238
1194767806
DULAM, VIKRAMADITYA MD
NATCHEZ
MS
09276533
1487874145
DULLI, AMMAR MD
GREENVILLE
MS
00116904
1972691020
DULSKE, MICHAEL G MD
FLOWOOD
MS
06225219
1770849580
DUMAL, KATHERINE R NP
GULFPORT
MS
00060742
1730308206
DUMAS JR, JAMES R DDS
PRENTISS
MS
03951004
1548333610
DUMAS, J D MD
HATTIESBURG
MS
00660358
1831200849
DUMAS, JOHN DALE
MCCOMB
MS
08655501
1629427174
DUNAWAY, AMANDA NP
MCCOMB
MS
00125232
1396794467
DUNBAR JR, MARVIN R MD
MONTICELLO
MS
00017748
1720020795
DUNCAN, ELBERT A
TUPELO
MS
00113106
1578653218
DUNCAN, ELIZABETH J APMHN
HERNANDO
MS
07270034
1427498849
DUNCAN, FORREST C MD
JACKSON
MS
00660311
1912074519
DUNCAN, JAMES D DDS
JACKSON
MS
00122184
1346250677
DUNCAN, JAMES L
JACKSON
MS
05989226
1649647256
DUNCAN, JENNIFER NP
PICAYUNE
MS
86
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01053866
1750520284
DUNCAN, MARK E ACNP
JACKSON
MS
04884551
1407834732
DUNCAN, SUSAN L NP
SUMMIT
MS
00119038
1518908854
DUNCAN, ULRIC D MD
SOUTHAVEN
MS
00060104
1790719169
DUNCAN, WILLIAM K DDS
JACKSON
MS
00125820
1881623650
DUNCOMBE, VANESSA L MD
BILOXI
MS
00112842
1134102296
DUNGAN, VINCENT C MD
MERIDIAN
MS
00088038
1114025772
DUNGEY, STEPHANIE P DMD
CLINTON
MS
09032253
1679931083
DUNHAM, HEATHER M PA-C
VICKSBURG
MS
02226091
1184663106
DUNIGAN, DAVID K MD
COLUMBUS
MS
00258817
1518115864
DUNLAP, CANDACE L ACNP
RIDGELAND
MS
09908710
1114187333
DUNLAP, PATRICIA MD
CHOCTAW
MS
07875564
1881928570
DUNN, ASHLI D FNP
COLUMBUS
MS
00060412
1003920489
DUNN, FREDERIC B DDS
CLARKSDALE
MS
07630049
1033290051
DUNN, III, JACK MD
HATTIESBURG
MS
00120346
1447358494
DUNN, LADONNA A CFNP
BRANDON
MS
00126582
1376584912
DUNN, THOMAS J DO
COLUMBUS
MS
04136595
1689929366
DUNSON, STACIA M FNP
TERRY
MS
05087873
1871604207
DUONG, MINH T OD
MERIDIAN
MS
07733218
1346415114
DUONG, SUSAN MD
JACKSON
MS
00124141
1811061831
DUPLANTIER, NOEL M MD
BAY ST LOUIS
MS
00124245
1639212442
DUPONT, JOANNA T MD
OCEAN SPRINGS
MS
03251719
1154319481
DURANT, HELEN
YAZOO CITY
MS
00110109
1689729287
DURFEY, JOHN J MD
JACKSON
MS
00124008
1730182007
DURGIN JR, HARRY W MD
MERIDIAN
MS
04171017
1033102066
DURHAM, ANNA M MD
OLIVE BRANCH
MS
03486012
1083017313
DURHAM, LAUREN V NP
BATESVILLE
MS
06287523
1083073233
DURR, MARY A PAC
JACKSON
MS
02181582
1497068134
DURR, SHARON L MSN
JACKSON
MS
87
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03184581
1144253626
DURRANI, EHSAN ULLAH K MD
JACKSON
MS
00122524
1033195953
DURRETT, SANDRA C NP
NEW ALBANY
MS
09977259
1891026126
DUTTA, GAURAV MD
COLUMBUS
MS
02274395
1871814871
DUVERNAY, BRIAN M DDS
CARRIERE
MS
04026701
1003972928
DVESS, JACKIE A CFNP
WHITFIELD
MS
00339814
1902820525
DVORAK, EDWARD I
OCEAN SPRINGS
MS
00121570
1649245549
DYE, BRADFORD J
OXFORD
MS
09389256
1831640911
DYE, HANNAH K APRN
OXFORD
MS
00064031
1538298492
DYER, CHARLES D DMD
MAGEE
MS
07804294
1184621021
DYESS, DEREK S
JACKSON
MS
00016375
1699783928
DYESS, ERIC M MD
JACKSON
MS
04139568
1518167832
DYESS, RENEE O MD
FLOWOOD
MS
08221211
1235201302
DYESS, TERI S MD
JACKSON
MS
08881077
1396123402
DYKES, JOSEPH L FNP
MAGNOLIA
MS
02502827
1548596166
DYKES, MATTHEW G PA-C
OCEAN SPRINGS
MS
00124038
1861474827
DYKES, PAUL G MD
BROOKHAVEN
MS
01078590
1386961167
DZIK, JUSTIN N MD
GULFPORT
MS
06825007
1861683203
DZUGAN, SERGEY S MD
HATTIESBURG
MS
09356261
1306906516
EADS, STEPHANIE P RN
GRENADA
MS
00927892
1972544427
EAKES, DAVID L MD
VICKSBURG
MS
00124216
1194739656
EAKES, PATRICK H MD
UNION
MS
09532791
1902860554
EAKIN, ELIANE F MD
RIDGELAND
MS
03978057
1578995692
EAKINS, GREGORY OD
SOUTHAVEN
MS
04026801
1710034509
EARL, TRUMAN M MD
JACKSON
MS
02508239
1740502095
EARLES, AARON C DO
CORINTH
MS
00024308
1912981085
EARLEY, BONNIE E ACNP
MERIDIAN
MS
09128041
1376752832
EARNEST, DALLAS M FNP
CLARKSDALE
MS
02282561
1194142703
EARNEST, JENNAGRACE C CNP
TUPELO
MS
88
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04456521
1720485600
EASLEY, AMY W NP
BRANDON
MS
00679304
1750423919
EASLEY, DAVID P MD
HATTIESBURG
MS
01159709
1295125813
EASLEY, JENNIFER K CPNP
JACKSON
MS
06434356
1891100970
EASLEY, JILL T NP
MADISON
MS
00079248
1184960437
EASLEY, MELISSA L NND-B
FLOWOOD
MS
01459854
1952570723
EASON HINTON, RONDA CFNP
LUMBERTON
MS
00088059
1417048620
EASON, RANDY D
FOREST
MS
00121948
1932132495
EAST, HONEY E MD
JACKSON
MS
02552255
1457761611
EASTER, SABRINA G AGNP-
TUTWILER
MS
00117189
1568486124
EASTERLING, NANCY R CFNP
COLUMBIA
MS
00114107
1154359818
EASTERLING, STANLEY MD
VICKSBURG
MS
08278058
1003137084
EASTLACK, JASON P MD
BAY SPRINGS
MS
03027554
1679855159
EATON, JESSICA W
TUPELO
MS
08580587
1164477261
EATON, RENATE S NP
BOONEVILLE
MS
08759340
1750732582
EAVES, AMANDA L PMHNP
SOUTHAVEN
MS
08278310
1255447645
EAVES, NANCY CPNP
LAUREL
MS
00113174
1386672970
EBEID, MAKRAM R M.D.
JACKSON
MS
05608020
1235172206
EBY, THOMAS L MD
JACKSON
MS
00126524
1154327989
ECCLES-JAMES, KED N MD
LAUREL
MS
07723789
1821455734
ECHOLES, LAJAYSHA K FNP-B
OXFORD
MS
00255734
1255392841
ECHOLS WILLIAMS, QUENYATTA MD
SEMINARY
MS
09677208
1538440425
ECHOLS, KANDAICE OD
MAGEE
MS
02373861
1295934529
ECKARD, BETH OD
TUPELO
MS
05679035
1932102779
ECKARD, DAX M OD
TUPELO
MS
00977248
1699768754
ECKMAN, WALTER W MD
TUPELO
MS
04976388
1598968158
EDDINE, AHMAD MD
JACKSON
MS
01301887
1821209784
EDDLEMAN, KIRK MD
OXFORD
MS
00660269
1346335486
EDGAR, WILLIAM P DDS
BRANDON
MS
89
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02656571
1881077717
EDINGTON, WALTER B FNP
VARDAMAN
MS
06230032
1508934464
EDMISTON, BART J MD
OCEAN SPRINGS
MS
00115170
1588732366
EDMONDSON, HENRY L MD
STARKVILLE
MS
00014322
1720026255
EDMONDSON, MARSHALL G
TUPELO
MS
00117462
1689617664
EDMONSON, JAMES D
CORINTH
MS
00209211
1528031077
EDMONSON, WILLIAM R MD
TUPELO
MS
00114108
1699702936
EDNEY, DANIEL P M.D.
VICKSBURG
MS
05885307
1386720241
EDRINGTON, BETTY D FNP
LONG BEACH
MS
00087660
1336172428
EDRINGTON, MAX M OD
LONG BEACH
MS
05480269
1881608115
EDUPUGANTI, HEMA M MD
GULFPORT
MS
01529099
1740347483
EDWARDS HAGER, HEATHER H FNP
GREENVILLE
MS
00110512
1255408332
EDWARDS JR, JOSEPH D
BRANDON
MS
07431222
1285815613
EDWARDS, BELINDA M NP
MERIDIAN
MS
09823097
1649434754
EDWARDS, BETHANY B FNP
NORTH CARROLLTON
MS
05683563
1215224563
EDWARDS, CEDRIC MD
SENATOBIA
MS
03373776
1275898918
EDWARDS, ELIZABETH F CFNP
BATESVILLE
MS
00776741
1659405793
EDWARDS, KENNY B MD
COLUMBUS
MS
05783386
1962678037
EDWARDS, LEIGH B MD
JACKSON
MS
01077076
1467983601
EDWARDS, LORI NP
GULFPORT
MS
00138027
1336550425
EDWARDS, MEGAN B DO
JACKSON
MS
04571243
1134298441
EDWARDS, REBECCA R DDS
OXFORD
MS
03420071
1023082542
EDWARDS, ROBERT L MD
MAGNOLIA
MS
00880206
1013015585
EDWARDS, STEPHEN P
WATER VALLEY
MS
06131078
1710363130
EDWARDS, VALEXIA J DMD
GULFPORT
MS
00111109
1497905079
EDWARDS, VERSHEEN DPM
RIDGELAND
MS
00437561
1023431517
EGBERT, CHRISTY L FNP
SOUTHAVEN
MS
00016083
1427139708
EGGER, EDWIN G MD
GREENVILLE
MS
09831521
1609057934
EID, ISSAM N MD
JACKSON
MS
90
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00832561
1174830038
EILAND, ELOSHA J MD
MOUND BAYOU
MS
07585750
1063634863
EISENHUTH, KATHRYN K MD
GULFPORT
MS
00114104
1578678868
EKENNA, OKECHUKWU MD
MOSS POINT
MS
00150273
1013172055
EL FEGHALY, RANA MD
JACKSON
MS
05553563
1932310547
EL JAMAL, SIRAJ M MD
JACKSON
MS
03377586
1376905455
EL MALLAH, RANDA D MD
JACKSON
MS
03158392
1881824712
EL-ASHRY, AWAD MD
MERIDIAN
MS
06877552
1912225665
EL-FARRA, JAMIL T MD
JACKSON
MS
08259084
1699975425
ELDRED, EDWARD B DO
OLIVE BRANCH
MS
00019076
1316972516
ELDRIDGE, ANTHONY R
TUPELO
MS
01733711
1083655724
ELGIN, LISA B
ABERDEEN
MS
07407543
1669797940
ELHASSAN, MOHAMED MD
JACKSON
MS
05006798
1134570377
ELHUSSEINY, HEBATALLA M MD
JACKSON
MS
08827339
1699981639
ELKINS, CAMILLE T MD
OCEAN SPRINGS
MS
01434378
1003122821
ELKINS, JOHN C CRNP
PASCAGOULA
MS
00096397
1336176817
ELKINS, STEPHANIE MD
JACKSON
MS
04552516
1033223599
ELLENDER, CLAIRE PA
SOUTHAVEN
MS
05321591
1851537153
ELLER III, RONALD N PAC
JACKSON
MS
00385756
1518992833
ELLER, RONALD PA
VICKSBURG
MS
00120845
1427066083
ELLINGSON, THOMAS L MD
BRANDON
MS
00013009
1063482404
ELLIOTT, CHARLES
RIPLEY
MS
00123149
1023109089
ELLIOTT, KATHRYN B WHNP
OXFORD
MS
03754078
1184086282
ELLIOTT, LAUREN B MSN
JACKSON
MS
00120975
1184724718
ELLIOTT, MARK S
MERIDIAN
MS
00113221
1043342322
ELLIS III, DUNK A MD
MOSS POINT
MS
00016118
1336153014
ELLIS III, TELLIS B MD
JACKSON
MS
06832564
1528149531
ELLIS, DANIELLA S FNP
TUNICA
MS
00634567
1760699540
ELLIS, DANNY E NP
PORT GIBSON
MS
91
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00060353
1235347436
ELLIS, GEORGE E DMD
HAZLEHURST
MS
04587860
1063439503
ELLIS, JAMES DO
JACKSON
MS
00011250
1578566733
ELLIS, JAMES V MD
SENATOBIA
MS
05431821
1891950242
ELLIS, MARCHALEE MD
HATTIESBURG
MS
00112542
1598791535
ELLIS, MARK L MD
COLUMBUS
MS
09176333
1720352792
ELLIS, MELANIE W MSN
JACKSON
MS
01035561
1760646509
ELLIS, SHELLEY W DMD
MERIDIAN
MS
00087045
1659465508
ELLIS, WILLIAM B OD
INDIANOLA
MS
00113408
1699781948
ELLISON JR, RICHARD B
JACKSON
MS
05208342
1942311212
ELLISON, PARKER L MD
MADISON
MS
09783252
1922252477
ELLSWORTH, ANGELA M PA
HATTIESBURG
MS
00783253
1326302894
ELNOUR, HASSAN MD
JACKSON
MS
08376259
1255794103
ELOFSON, HOPE A MD
JACKSON
MS
03551301
1669774667
ELRIDGE, TAYLOR L CRNA
JACKSON
MS
03859313
1639477425
ELY, MARY CAY NP
CLEVELAND
MS
00236276
1528409968
ELZAMLY, KAREEM M MD
JACKSON
MS
03383302
1154509628
EMBRY, JAMES W NP
GULFPORT
MS
05032760
1386843407
EMBRY, MARGARET B NP-C
OXFORD
MS
00122796
1861542482
EMERICK, MATTHEW L
PASCAGOULA
MS
00126889
1033273313
EMERLE, AGNES
COLUMBIA
MS
08076251
1538298203
EMERSON, DELIA T NP
JACKSON
MS
00116720
1316985849
EMIG, ERIC W M.D.
TUPELO
MS
04354767
1265632178
EMISON, TRENY K NP
TUPELO
MS
00015185
1144213141
EMRICK, FRED G MD
NATCHEZ
MS
00005858
1992976070
ENGEL JR, EDWARD L DMD
GREENVILLE
MS
01106311
1811950058
ENGELKING, JON H MD
SOUTHAVEN
MS
00907827
1396715918
ENGELMANN, JOHN A MD
JACKSON
MS
00660403
1326159138
ENGER, DANIEL J DDS
PASCAGOULA
MS
92
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00113767
1265442594
ENGER, ERIC W MD
HATTIEBURG
MS
00017028
1720014939
ENGLAND, LESLIE E MD
NATCHEZ
MS
00477571
1215354691
ENGLISH, LAUREN M PA-C
HATTIESBURG
MS
04103589
1336266550
ENLOW, TARA B CFNP
FULTON
MS
00115468
1144320920
ENNIS, CALVIN MD
MOSS POINT
MS
05958040
1134581242
ENOS, JULIA A DO
JACKSON
MS
00112177
1073536785
ENTREKIN, DIANA L M.D.
JACKSON
MS
05170886
1013902725
EPPERSON, STEPHEN P MD
JACKSON
MS
07639518
1992806939
ERIATOR, IKECHUKWUI I MD
JACKSON
MS
00173017
1336333962
ERNST, JENNIFER A FNP
CORINTH
MS
07800576
1407143878
ERO, AMEZE MD
JACKSON
MS
00116292
1619903580
ERVIN JR., JAMES W
CRYSTAL SPRINGS
MS
02274745
1710249271
ERWIN, ANNA K FNP
CORINTH
MS
00124481
1972542512
ERWIN, JAMES W MD
GULFPORT
MS
02904837
1679707137
ERYAZICI, PAULA MD
BATESVILLE
MS
00111241
1710042585
ESCUDE, CRAIG L
WHITFIELD
MS
03875389
1295088854
ESHUN, DORCAS P MD
CLARKSDALE
MS
06629826
1376723148
ESPEY, ELON E PMHNP
NEWTON
MS
05023576
1699187393
ESSER, KIMBERLY R NP
GULFPORT
MS
02105259
1760724520
ESTARIS, ROLAND R MD
HATTIESBURG
MS
06858257
1699086751
ESTEP, JASON R DMD
POPLARVILLE
MS
00112797
1811963127
ESTES, CAROLYN CFNP
TUPELO
MS
04454726
1790911303
ESTES, KIMBERLY J MD
MEADVILLE
MS
00017048
1285746511
ESTES, TIMOTHY D MD
JACKSON
MS
00125993
1497865638
ESTESS JR, JOHN M MD
TUPELO
MS
00114400
1952305948
ESTESS, JOHN M
HOLLANDALE
MS
07879028
1801042890
ESTESS, JUSTIN R MD
BROOKHAVEN
MS
03237574
1548628522
ESTOCK, WESLEY W PA
TUPELO
MS
93
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00011327
1881749489
ETHRIDGE JR, H CLARK MD
JACKSON
MS
00011435
1386632560
ETHRIDGE, CHRIS P MD
JACKSON
MS
00011229
1043263841
ETHRIDGE, JESSE C MD
JACKSON
MS
00117720
1871529743
EUBANK, BETH CFNP
GREENVILLE
MS
00660364
1033207568
EUBANKS, CAROLYN G DMD
HOLLANDALE
MS
06456061
1073916557
EUBANKS, DANIELLE M NP-C
LEAKESVILLE
MS
05957065
1720241201
EUBANKS, JENNIFER T MD
JACKSON
MS
01303771
1518995521
EUBANKS, RICHARD S MD
OCEAN SPRING
MS
04451254
1356504872
EUBANKS, ROBERT MD
JACKSON
MS
07832356
1871593111
EUBANKS, TARRA NP
SOUTHAVEN
MS
06500868
1154789717
EURE, CARRIE W PA
VICKSBURG
MS
00087795
1972517506
EVANS JR, FRANK OD
CALHOUN CITY
MS
00060822
1174603823
EVANS JR, LOWELL G DDS
SARDIS
MS
00125971
1598847253
EVANS JR, S R
GREENWOOD
MS
03832715
1326335902
EVANS, CHARLES E DO
COLUMBUS
MS
08780039
1205921467
EVANS, CHRISTOPHER C OD
JACKSON
MS
00920835
1205972429
EVANS, DOUGLAS A
JACKSON
MS
01107391
1568907376
EVANS, ELIZABETH L NP
RULEVILLE
MS
09181241
1871791434
EVANS, ERIC C
MADISON
MS
05121044
1497901607
EVANS, HEATHER MD
JACKSON
MS
00121588
1164589891
EVANS, ISHAM H MD
OXFORD
MS
00014780
1396784187
EVANS, JACK C MD
LAUREL
MS
00115527
1053414326
EVANS, JEFFREY N MD
OXFORD
MS
03171856
1386193183
EVANS, JOANNIE NP
GULFPORT
MS
08435000
1528434214
EVANS, KATHRYN F NP
GREENWOOD
MS
07759844
1033514591
EVANS, LEANN N FNP-C
NEW AUGUSTA
MS
00127324
1508941782
EVANS, PHILIP J DMD
CHOCTAW
MS
00110273
1497067326
EVANS, ROBERT F DO
PASCAGOULA
MS
94
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00013859
1255349502
EVANS, ROBERT M MD
JACKSON
MS
00111136
1952465619
EVANS, ROY MD
BASSFIELD
MS
00120474
1720095896
EVANS, TIMOTHY J FNP
FULTON
MS
05187392
1982978771
EVANS, TRACI R NP
OCEAN SPRINGS
MS
03003227
1396980116
EVANS, VALERIE N MD
HATTIESBURG
MS
01257147
1619913761
EVANS, WILLIAM J MD
OCEAN SPRINGS
MS
00124246
1881600013
EVANS-ALEXANDER, DONNA H MD
BILOXI
MS
00705708
1003072604
EVANSON, J RICHARD L DO
STARKVILLE
MS
02331571
1700210424
EVERETT, LINDSAY E NP
TUPELO
MS
00010282
1356449078
EVERETT, T K MD
MERIDIAN
MS
02456309
1427136126
EVERS, NATALIE M MD
MORTON
MS
08188777
1649294265
EWALEIFOH, BENEDICT E MD
MCCOMB
MS
00122361
1083601538
EZE, PLACID M MD
STARKVILLE
MS
02975041
1487004560
EZELL, EMILY S
TUPELO
MS
03073238
1629361340
EZEUME, CHUKWUEMEKA N MD
TUPELO
MS
03489529
1992844815
EZZEH, MARY ANN B DPM
YAZOO CITY
MS
00122006
1912911843
EZZELL, JESSE H MD
LAUREL
MS
02200834
1649652652
FACEY, GABRIELLE S MD
JACKSON
MS
04888572
1073944971
FAGAN, ANGELA J NP
JACKSON
MS
00359815
1669683405
FAGAN, BRYAN C MD
TUPELO
MS
03830229
1770538217
FAGAN, CHRISTOPHER H MD
JACKSON
MS
00016970
1801827019
FAGAN, JOHN D MD
VICKSBURG
MS
06852827
1447261649
FAILS, JENNIFER M NPC
CARTHAGE
MS
00016739
1497818579
FAIN, GEORGE D MD
OCEAN SPRINGS
MS
06889340
1699137786
FAIR, LOGAN D MD
JACKSON
MS
02672857
1215949896
FAIRBANKS, MICHAEL W FNP
GULFPORT
MS
00123219
1033154794
FAIRCHILD, LISA D M.D.
VICKSBURG
MS
09782541
1477909596
FAIRCHILD, RACHEL B NP-C
FLOWOOD
MS
95
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02986011
1972984136
FAIRLEY, JOANNE NP
GULFPORT
MS
01024243
1033534391
FAISON, BETHANY L PA-C
TUPELO
MS
06383814
1679730329
FAKOREDE, FOLUSO A MD
GREENVILLE
MS
00119223
1205881307
FALLS, ANITA J
HOUSTON
MS
03927741
1891825287
FAMUYIDE, MOBOLAJI MD
JACKSON
MS
05128206
1588046155
FANCHER, DEVIN C NP
TUPELO
MS
01509235
1881694347
FARABAUGH, PAUL B MD
TUPELO
MS
09870733
1609188846
FARAH, NOURELHODA I MD
JACKSON
MS
00118301
1710011499
FARINA JR, JOSEPH W MD
MCCOMB
MS
05206270
1811130917
FARINO, JETHER MD
BILOXI
MS
04389018
1164833968
FARKAS, AMY MD
JACKSON
MS
05600025
1497192876
FARLAND, TAYLOR DDS
MERIDIAN
MS
07721059
1750475331
FARLEY, EDWARD P MD
JACKSON
MS
00118038
1407856958
FARMER II, CLARANCE S
TUPELO
MS
05924350
1336118843
FARMER, GUY R DO
NEW ALBANY
MS
00826710
1366749152
FARMER, JERILYN D NP-C
OCEAN SPRINGS
MS
05375702
1891727640
FARMER, JOHN C MD
JACKSON
MS
05857711
1215134010
FARMER, LASHONDRA J FPNP
JACKSON
MS
07686086
1609187749
FARMER, LINDA M ACNP
MERIDIAN
MS
00121725
1326082835
FARMER, MICHAEL C DO
HATTIESBURG
MS
00123193
1902840861
FARMER, WILLIAM D MD
OXFORD
MS
00959507
1558374850
FARMER, WILLIAM M
HATTIESBURG
MS
07322002
1346337623
FARNER, KELLEY J ARPN
CARTHAGE
MS
08328740
1639287295
FARQUHARSON, ROBERT R MD
TUPELO
MS
04608339
1316370356
FARR, COLEMAN R CNP
JACKSON
MS
08283340
1114379427
FARR, JOHN R PMHNP
MADISON
MS
07688593
1801294772
FARRAR, DONALD J DO
MERIDIAN
MS
08379802
1174569578
FARRAR, ELIZABETH V MD
MERIDIAN
MS
96
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00112512
1649206210
FARRAR, GAIL K MD
LONG BEACH
MS
00117504
1326093865
FARRAR, THOMAS C MD
OLIVE BRANCH
MS
09571374
1033319389
FARRELL, KATHRYN R MD
FLOWOOD
MS
07309822
1154763514
FARRELL, STACEY NP
CLEVELAND
MS
00117297
1669482907
FARRELL, STEVEN MD
HATTIESBURG
MS
00120443
1649364860
FARYABI, FARZAD DPM
JACKSON
MS
00011842
1609960889
FAUCETT, DONALD C MD
RULEVILLE
MS
08757065
1043522352
FAUGHT, RACHAEL DO
GREENWOOD
MS
00581854
1073953337
FAULCONER, WHITNEY K DO
JACKSON
MS
00120599
1184723280
FAULK, CATHERINE C MD
JACKSON
MS
09338308
1518254713
FAULKENBURY, LISA M FNP
VICKSBURG
MS
08880771
1134460736
FAULKNER, EDITH W CFNP
WEST POINT
MS
00308019
1972536837
FAUST, JOHN MD
JACKSON
MS
03459830
1215195631
FAVA, KIMBERLY T WHCNP
CLARKSDALE
MS
05651772
1265854806
FAVA, MARGARET D NP
BOONEVILLE
MS
05636313
1073806246
FAVRE, CASEY M NP
BAY ST LOUIS
MS
07334011
1912265943
FAVRE, ERIN E NP
BAY STLOUIS
MS
00739201
1548273576
FAWAD, LUBNA DDS
JACKSON
MS
09129044
1114126042
FAYARD, NICHOLAS J MD
PASCAGOULA
MS
05001507
1932389681
FEAGANS, JACOB M MD
HATTIESBURG
MS
06987390
1992739817
FEDUCCIA, THOMAS A MD
GULFPORT
MS
02323261
1225065568
FEIG, CLAUDINE H
HATTIESBURG
MS
01157501
1033181722
FEIND, CARL R MD
MCCOMB
MS
00114923
1134174097
FELDER, ELIZABETH M MD
HATTIESBURG
MS
00660150
1578715322
FELDER, JOHN T DMD
MCCOMB
MS
00660272
1902802655
FELDER, PAUL DDS
BAY SPRINGS
MS
00123365
1841297983
FELLOWS, WILLIAM R MD
GULPORT
MS
05189370
1942368493
FELTON, DAVID A DDS
JACKSON
MS
97
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02356765
1851731848
FELTON, DONOIR A MD
JACKSON
MS
03209272
1821450073
FENG, JONATHAN N MD
JACKSON
MS
03479208
1497965974
FENTON, JOSHUA S MD
TUPELO
MS
00854818
1881958262
FERACHI, LARRY G MD
JACKSON
MS
01829002
1255599601
FERDINAND JR., LARRY MD
OCEAN SPRINGS
MS
03788524
1831156496
FERGUSON JR, EDWARD R MD
TUPELO
MS
00119322
1326120056
FERGUSON, BAILEY J MD
MAGEE
MS
09629811
1154791028
FERGUSON, LAURA H CFNP
COLUMBUS
MS
03635371
1891188660
FERGUSON, LEE C NP
TUPELO
MS
09550236
1114239423
FERGUSON, LEE M MD
FLOWOOD
MS
00103035
1578639449
FERMAN, BRETT A
MCCOMB
MS
01280867
1851656656
FERNANDEZ GARCIA-ROVES, DIEGO MD
LAUREL
MS
00123815
1144230491
FERNANDEZ, JOSE P
HATTIESBURG
MS
02128275
1669457925
FERO, JOSEPH P NP-C
VANCLEAVE
MS
01855262
1376576652
FERRIS, CAROLINE G MD
HATTIESBURG
MS
00114431
1235168626
FERRIS, EUGENE B MD
VICKSBURG
MS
02755008
1205065596
FERRISS, PATRICK M DO
KOSCIUSKO
MS
04038362
1154684363
FEWELL, KELLI S NNPBC
MAGEE
MS
00116793
1982634937
FIELD, CYNTHIA
JACKSON
MS
00118675
1861595118
FIELD, EDWARD D MD
OXFORD
MS
00115547
1548217847
FIELD, III, RICHARD J MD
CENTREVILLE
MS
00113626
1073501250
FIELD, LARRY D
JACKSON
MS
06478544
1578975017
FIELDER, ANGELA D MD
JACKSON
MS
00660178
1790803039
FIELDS, JOHN F DMD
COLUMBUS
MS
01253366
1225340151
FIELDS, MATTHEW S MD
OLIVE BRANCH
MS
00087640
1073595906
FIELDS, RODERICK D OD
BILOXI
MS
08302531
1164469771
FIGAROLA, SARAH E PA
VICKSBURG
MS
01934769
1457357691
FIGAROLA, TULIO A MD
VICKSBURG
MS
98
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00117797
1134236128
FIGUEROA, ALFREDO H MD
JACKSON
MS
04836860
1184162752
FIGUEROA, CATHERINE NP
JACKSON
MS
03636020
1437149408
FIGUEROA, GLENN MD
BAY SAINT LOUIS
MS
08784852
1912167594
FIGUEROA-GARCIA, ALBERTO MD
TUPELO
MS
00017458
1558398909
FILES, JOE C MD
JACKSON
MS
00116048
1346261195
FILLINGANE, CHARLES S DO
FLOWOOD
MS
06475751
1114969656
FINCH III, MARCUS D PA-C
PETAL
MS
09083707
1467639211
FINCH, PENNY L
CALEDONIA
MS
00060282
1104048693
FINCHER, WALLACE T DDS
CARROLLTON
MS
00087730
1134261282
FINDLEY, ALLEN D OD
JACKSON
MS
00152807
1710997077
FINK, SEAN D MD
HATTIESBURG
MS
08373277
1982630463
FINLAY, DARRELL G MD
PASCAGOULA
MS
07606392
1174817035
FINLEY, AMANDA J DO
CORINTH
MS
00012868
1992732044
FINLEY, RICHARD MD
JACKSON
MS
00017354
1043225527
FISER, H. G
JACKSON
MS
00113525
1639125768
FISHER, JAMES K
LAUREL
MS
02478248
1760877948
FISHER, JASON A
HATTIESBURG
MS
00018019
1316006414
FISHER, ROBERT M MD
SOUTHAVEN
MS
07457571
1467886937
FISHER, THOMAS P NP
YAZOO CITY
MS
00125223
1912945973
FISHKIN, SEMYON MD
JACKSON
MS
00660324
1356474266
FITCHIE, JAMES G DMD
JACKSON
MS
00018870
1336133453
FITE, JAMES W MD
GRENADA
MS
00121374
1417931403
FITTS, MYRA E FNP
MS STATE
MS
00125498
1366451049
FITTS, TANYA J
OXFORD
MS
01625292
1861508558
FITTS, TERESA L FNP
TOCCOPOLA
MS
07753816
1164449740
FITZGERALD, JEFFREY S MD
HATTIESBURG
MS
00116947
1467462465
FITZPATRICK, JOHN M MD
HATTIESBURG
MS
05170544
1689996282
FIVEASH, PHYLLIS FNP
CORINTH
MS
99
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00981393
1497715221
FLAGG, DEBORAH K RN
BILOXI
MS
09556847
1134441587
FLAKE, ERICA D PMHNP
PHILADELPHIA
MS
00016221
1104899129
FLANNERY, ALPHONSUS L
CORINTH
MS
01435098
1164630349
FLANTROY, KESHA M MD
JACKSON
MS
00122080
1801845136
FLATTMANN, GEOFFREY J MD
NATCHEZ
MS
00113766
1760553655
FLAUTT II, HENRY F MD
GREENWOOD
MS
02375347
1215342241
FLAUTT, THOMAS J DO
WINONA
MS
00018719
1497734412
FLEETWOOD, BARBARA A
STARKVILLE
MS
07258508
1902943764
FLEISCHHAUER, THOMAS F MD
HOLLY SPRINGS
MS
03136015
1841735339
FLEITAS, LISA NP
AMORY
MS
06402241
1801016134
FLEMING, BENJAMIN K PA
GULFPORT
MS
01808332
1154586089
FLEMING, EMILY K OD
LOUISVILLE
MS
08820505
1538361027
FLEMING, KAREN A CFNP
GREENVILLE
MS
08400059
1952795502
FLEMING, KATHRYN L NP
HATTIESBURG
MS
07183701
1205128725
FLEMING, LATISHA M NP
GULFPORT
MS
00954376
1780622712
FLEMING, MARY A FNP
TUPELO
MS
00124115
1093726739
FLEMMING, DAVID T
PEARL
MS
00119913
1861451510
FLETCHER, AUDWIN B
JACKSON
MS
09406232
1881968915
FLETCHER, CHRISTOPHER M NP
PICAYUNE
MS
00936767
1407390438
FLETCHER, ESQUANICKIA FNP
BRANDON
MS
00111237
1114982485
FLETCHER, GARDNER L MD
HATTIESBURG
MS
00010362
1679517585
FLETCHER, JEFFERSON A MD
JACKSON
MS
00113724
1225021371
FLETCHER, MARK H MD
TUPELO
MS
06404762
1669851846
FLETCHER, STEPHEN G DO
JACKSON
MS
00116035
1063479723
FLETCHER-VINCENT, SHERYLL F MD
JACKSON
MS
00500349
1811308828
FLISS, PETER M DO
JACKSON
MS
08837545
1932542586
FLOOD, ALEXANDER T DO
HATTIESBURG
MS
00120002
1801953609
FLOREZ, RAFAEL D MD
MERIDIAN
MS
100
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08620331
1104991389
FLORIANI, CLAYTON C
SOUTHAVEN
MS
00129320
1730183435
FLORIDA, MARLON A MD
CHOCTAW
MS
00116191
1356364905
FLOWERS III, RICHARD H MD
JACKSON
MS
02929848
1215222179
FLOWERS, DEBBIE S FNP
LAUREL
MS
03958367
1306057807
FLOWERS, DWIGHT T
MERIDIAN
MS
00115329
1144245317
FLOWERS, ELIZABETH R
JACKSON
MS
07555720
1376948240
FLOWERS, FREDERICK W FNPBC
JACKSON
MS
00115046
1306812987
FLOWERS, HARVEY A MD
TUPELO
MS
07385847
1649659731
FLOWERS, JONATHAN G DO
JACKSON
MS
06320801
1366778516
FLOWERS, KERRIN A FNP
TUTWILER
MS
09830048
1386190627
FLOWERS, SHELLY L
OLIVE BRANCH
MS
03159851
1942749874
FLOWERS, TRESLEON NP
MERIDIAN
MS
00113299
1336223163
FLOWERS, WILLIAM C
JACKSON
MS
01153067
1073516456
FLOWOOD FAMILY VISION
FLOWOOD
MS
07702276
1972859809
FLOYD, AMY V DNP
GRENADA
MS
00114707
1457345365
FLOYD, HERBERT B
PETAL
MS
08977735
1164620761
FLOYD, JOHN D MD
WHITFIELD
MS
09909876
1174075220
FLOYD, KEVIN A CFNP
TUPELO
MS
02785041
1356713903
FLOYD, MITZI NP
BRANDON
MS
03007738
1124217567
FLOYD, MOLLI L MD
TUPELO
MS
00118255
1841313251
FLOYD, PATRICIA K CFNP
RIENZI
MS
00012127
1407942279
FLY, JAMES D MD
JACKSON
MS
05156038
1760618292
FLYNN, MATTHEW E NP
HATTIESBURG
MS
00019329
1376516849
FLYNT, JOEL R
JACKSON
MS
00119817
1235197096
FOKAKIS, ARTHUR N MD
HATTIESBURG
MS
00121747
1801009592
FOLEY, LISA D FNP
TUPELO
MS
09609794
1417396565
FOLEY, MEGHAN E CFNP
NEW ALBANY
MS
00016500
1629010012
FOLK III, BENJAMIN P
GREENVILLE
MS
101
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08955542
1023456720
FOLSE, JACOB M MD
JACKSON
MS
00122042
1811929292
FOLSE, YVETTE S MD
HATTIESBURG
MS
04537068
1700211141
FOMIN, ALEXEY MD
HATTIESBURG
MS
05976078
1851792626
FONDREN, AMANDA NP
WEST POINT
MS
09280201
1124170451
FONTAN, JASON S M.D.
PASCAGOULA
MS
00014563
1649211277
FONTENOT, JOSEPH L MD CL
GAUTIER
MS
00014411
1932286978
FOOSE, ROBERT M MD
CHOCTAW
MS
00112687
1609977990
FORBES, ROBERT C MD
JACKSON
MS
00880151
1902826696
FORD II, REAGAN L OD
STARKVILLE
MS
09755751
1114387123
FORD, BALEIGH V PA-C
VICKSBURG
MS
07509343
1376815134
FORD, GRACE P FNP
BROOKLYN
MS
00122187
1073518817
FORD, III, VICTOR J
JACKSON
MS
00124996
1356363915
FORD, JOHN R MD
VICKSBURG
MS
03221576
1265869895
FORD, MARIE S FNP
MERIDIAN
MS
07927740
1346652377
FORD, RACHEL NP-C
BRANDON
MS
00087840
1124048277
FORD, REAGAN L OD
COLUMBUS
MS
00120414
1912922949
FORD, TERRY D DO
MERIDIAN
MS
04586327
1225281868
FORD, VICTORIA A FNP
HATTIESBURG
MS
07388276
1982953402
FORDHAM, JESSICA R FNP
YAZOO CITY
MS
07131718
1265589089
FORDHAM, ZACKARY W MD
HATTIESBURG
MS
03872050
1407969843
FORE, DANIEL B MD
SOUTHAVEN
MS
01604356
1003281916
FOREMAN, JENNIFER N NP
JACKSON
MS
00119587
1164499190
FORKS, THOMAS P DO
JACKSON
MS
00113668
1528089794
FOROPOULOS, JOHN E MD
CORINTH
MS
00121393
1043326986
FORREST, AMY M CFNP
TUPELO
MS
02808362
1205249471
FORRESTER, LORI NP
TUPELO
MS
07628011
1598865537
FORSYTHE, AMY R FNP
JACKSON
MS
01836730
1356422034
FORT, NELSON F DDS
MERIDIAN
MS
102
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00115047
1811963408
FORTENBERRY, FRANK S MD
TUPELO
MS
02775292
1083936132
FORTENBERRY, SUSAN C DMD
JACKSON
MS
07602357
1588974364
FORTHNER, LAKENYA FNP
HATTIESBURG
MS
00128800
1407044027
FORTIER, KIMBERLY E PA-C
PASCAGOULA
MS
07059201
1992139976
FORTNER, JAMIE V FNP
OXFORD
MS
00017199
1861538951
FORTUNE, JAMES E MD
SOUTHAVEN
MS
01338520
1659607232
FOSTER, CINNAMON C FNP
WATER VALLEY
MS
00660222
1295849354
FOSTER, DONNA L DMD
BROOKHAVEN
MS
00118868
1093773202
FOSTER, DONNA S CFNP
PELAHATCHIE
MS
01753371
1245696848
FOSTER, KRISTIN R FNP-C
NATCHEZ
MS
00529008
1962854323
FOSTER, LAURIE E NP
JACKSON
MS
00018625
1447397427
FOSTER, MICHAEL E MD
OLIVE BRANCH
MS
08174256
1528379831
FOSTER, MICHAEL W MD
JACKSON
MS
07232856
1275942369
FOSTER, ROBERT W NP
WEST POINT
MS
09353249
1356653877
FOUCHE, MARYLIN J MD
JACKSON
MS
03285886
1396017646
FOUQUIER, MARY K CNM
JACKSN
MS
00886302
1215224886
FOWLER, AMANDA H MD
JACKSON
MS
01386207
1568667723
FOWLER, BLAKELY A MD
CORINTH
MS
07305754
1447421409
FOWLER, LAURIE E NP
AMORY
MS
04386569
1386197697
FOWLER, SCOTT A FNP
LAUREL
MS
00124147
1346260460
FOX, ERVIN
JACKSON
MS
06538373
1427230713
FOX, GREGORY B DO
GAUTIER
MS
00119756
1407859887
FOX, HENRY C
HATTIESBURG
MS
06122531
1508313446
FOXWORTH, LORI S CNP
HATTIESBURG
MS
02488503
1629199633
FRAISER, JACQUELINE A CRNP
CORINTH
MS
08925881
1134377187
FRANCESKI, BARBARA D NP
BAY ST LOUIS
MS
04839391
1326093915
FRANK HITT, ERICA M MD
GULFPORT
MS
07584202
1245436799
FRANK, MATTHEW MD
GULFPORT
MS
103
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00123814
1558305722
FRANK-TARSI, MARY ANNE MD
GRENADA
MS
02158255
1912327289
FRANKE, JESSICA K NP
GULFPORT
MS
03100746
1366492365
FRANKLIN, ALAN J MD
BILOXI
MS
01620521
1528042801
FRANKLIN, BRAD A DMD
FLORA
MS
09426829
1295126910
FRANKLIN, FARRYL T OD
VICKSBURG
MS
00112514
1619906179
FRANKLIN, JOHNNY B MD
GULFPORT
MS
05375800
1649567983
FRANKLIN, LAURA N DMD
FLORA
MS
02324272
1720180979
FRANKS, JOY Y NP
MANTACHIE
MS
00120559
1699781765
FRANS, ZANDRA D FNP
TUPELO
MS
07355037
1306880661
FRASCOGNA, MELISSA N MD
JACKSON
MS
00011047
1609983725
FRASER JR, LIONEL B MD
JACKSON
MS
01131571
1013968965
FRATESI, SARAH B
STARKVILLE
MS
00015139
1851314033
FRAZIER, RANDALL P MD
CORINTH
MS
00122261
1336243047
FRAZIER, WILLIAM D MD
JACKSON
MS
00114773
1063498707
FRAZIER-GRIFFIN, VALERIE APRN
HORN LAKE
MS
00113670
1730138843
FREDERICKS, RUTH K MD
JACKSON
MS
01639881
1689710402
FREDRICKSON, JENNIFER B NP
SOUTHAVEN
MS
00123187
1770942146
FREED, SARAH L DPM
OLIVE BRANCH
MS
08356501
1215209986
FREEMAN, AMANDA L FNP
LAUREL
MS
05608014
1639383359
FREEMAN, CARRIE L MD
JACKSON
MS
05400876
1356452791
FREEMAN, ERWYN E MD
JACKSON
MS
04781825
1417934357
FREEMAN, FRANK B
LIBERTY
MS
07524385
1083075907
FREEMAN, JOHN N MD
JACKSON
MS
00127072
1497782742
FREEMAN, LAURA A
JACKSON
MS
07882391
1215986963
FREEMAN, MARC B MD
MCCOMB
MS
02975221
1265510440
FREEMAN, SHAUNDA T NP
JACKSON
MS
07638331
1952366080
FREEMAN, TIJUANA L MD
OCEAN SPRINGS
MS
09452565
1265898282
FREEMAN, TONYA H FNP
CORINTH
MS
104
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05388848
1114976099
FREI, LONNIE W
JACKSON
MS
07637854
1093024614
FRENCH, CALVIN J CFNP
COLUMBUS
MS
00119082
1295704989
FRENCH, ROBERT S CRNP
JACKSON
MS
00060471
1982777868
FRENCH, RODNEY A DMD
FLOWOOD
MS
07322393
1730386608
FRENCH, SARAH E MD
TUPELO
MS
08452314
1124238449
FRENCH, SHAWN K DO
OCEAN SPRINGS
MS
00123656
1255336749
FRENCH, TERRY M DO
MERIDIAN
MS
00118593
1013919216
FRIEDMAN, RICHARD B MD
JACKSON
MS
00123532
1699715102
FRIEDRICH, CHRISTOPHER A MD
JACKSON
MS
06182000
1265698195
FRIEL, MICHAEL T MD
JACKSON
MS
00481340
1518111574
FRIER, JILL OD
VICKSBURG
MS
06026073
1710935838
FRIEZE, TODD W MD
BILOXI
MS
00118741
1679562748
FRILOUX, MARK A MD
ABERDEEN
MS
05431861
1487066411
FRISCHHERTZ, JASON H MD
JACKSON
MS
02355853
1073925004
FRISCHHERTZ, VICTORIA A MD
JACKSON
MS
00126610
1700888906
FROHN, WILLIAM E MD
NEW ALBANY
MS
06608304
1518217413
FROSSARD, STEPHEN M DO
WINONA
MS
00653352
1821409905
FROST, KADIE B MD
JACKSON
MS
06681556
1215953971
FROTHINGHAM, RODNEY E MD
GREENVILLE
MS
05970562
1740331099
FRYE JR, CHARLES R MD
PASCAGOULA
MS
04809861
1194790287
FRYE, RONALD M MD
FAYETTE
MS
04338295
1407895725
FRYERY, SHANNON M NP
TUPELO
MS
05532315
1831553700
FRYOUX, JORDAN T MD
JACKSON
MS
00084891
1184703118
FULCHER, BEVERLY C MD
JACKSON
MS
00111649
1124097191
FULCHER, TODD L M.D.
BRANDON
MS
00111275
1497938690
FULLENWIDER, JOHN P MD
OXFORD
MS
02832037
1700086006
FULLER, CHASE PA-C
JACKSON
MS
00123943
1689688301
FULLER, JAMES M MD
FLOWOOD
MS
105
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04635513
1053667758
FULLER, JAY A OD
BILOXI
MS
07281200
1083860324
FULLER, KIMBERLY B ACNP
VICKSBURG
MS
01329390
1962844597
FULTON, AUBREY V OD
COLUMBIA
MS
05207259
1316495328
FULTON, KARLA M NP
STARKVILLE
MS
01955831
1720411762
FULTON, KATHERINE A NP
JACKSON
MS
07731211
1427149582
FULTON, LORI J MD
JACKSON
MS
03285872
1427431428
FULTON, PATRICE NP
OCEAN SPRINGS
MS
03781594
1013206416
FUNK, ZACHARY MD
PICAYUNE
MS
02300532
1821292046
FUNKHOUSER, JOHN C CFNP
JACKSON
MS
04286021
1962792093
FURDGE, MAURICE L MD
TUPELO
MS
00117703
1639250459
FURNISS, JAN L MD
JACKSON
MS
00118979
1093817306
FURR, ANGELA E FNP
HOULKA
MS
07236043
1538518519
FURR, MELANIE E PA-C
JACKSON
MS
00236384
1073569018
FUSSELL, STEPHANIE MD
GULFPORT
MS
09481205
1124221601
FUTVOYE, MATTHEW C MD
FLOWOOD
MS
00116537
1780609362
FYKE III, FRAZIER E
JACKSON
MS
00073841
1285810143
FYKE, KRISTEN T MD
STARKVILLE
MS
03925314
1962406298
GABER, EDWARD M M.D.
PASCAGOULA
MS
00660373
1528160140
GADDIS, ANDREA R DDS
MERIDIAN
MS
04089204
1205896842
GADDIS, LORRAINE K FNP
COLUMBUS
MS
00126171
1831130715
GADDIS, RUTH C CFNP
FOREST
MS
09920352
1689037285
GADDY, BRYAN E MD
JACKSON
MS
00115973
1659358869
GADDY, DONALD K MD
GULFPORT
MS
00013310
1730298506
GADDY, IRA E MD
GULFPORT
MS
00115974
1982681243
GADDY, JR, JAMES H M.D.
GULFPORT
MS
02304794
1538287479
GADDY, KATHRINE I WHNP
GULFPORT
MS
05529316
1558625921
GADELMOLA, KAREEM MD
JACKSON
MS
00125422
1205802667
GAINES, MATTHEW T MD
TUPELO
MS
106
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05728732
1932576998
GAINES, MISTY N NP
JACKSON
MS
02678704
1376692400
GAINS, MICHELE J MD
BRANDON
MS
02033047
1588942460
GAJAGOWNI, RAGHAVENDRAN G MD
TUPELO
MS
05158239
1710113998
GAJULA, VISWANATH MD
TUPELO
MS
05028310
1497800627
GALARZA, IVONNE E MD
JACKSON
MS
01556397
1538459078
GALBRAITH, LEAURA B NP
AMORY
MS
06153377
1760460133
GALE, DONALD H MD
HATTIESBURG
MS
03500355
1649490566
GALJOUR, GEORGE C MD
COLUMBUS
MS
06158079
1679716153
GALL, JOHN A MD
OXFORD
MS
06903511
1578784773
GALLAHER, PRESTON C MD
BATESVILLE
MS
00123829
1336159607
GALLARDO, MARK A
HATTIESBURG
MS
00114208
1780615088
GALLI, ROBERT L MD
JACKSON
MS
00123174
1073507547
GALLOWAY, KEVIN L DO
JACKSON
MS
00115186
1376553222
GALLOWAY, RICHARD MD
HATTIESBURG
MS
00019473
1841238540
GAMBLE II, HUGH A MD
GREENVILLE
MS
08672743
1487618708
GAMBLE, WILLIAM B MD
SENATOBIA
MS
05600238
1023338761
GAMBLIN, JEFFERSON R DMD
HAZLEHURST
MS
02927247
1730476367
GAMBRELL, KIRSTEN R MD
JACKSON
MS
07870552
1659550127
GAMMEL, STEVEN D MD
WINONA
MS
00118781
1962512590
GAN LIM, LEONIL A MD
TUPELO
MS
08021036
1487066759
GANDHI, SWENI MD
JACKSON
MS
00011592
1841411790
GANDY, DAVID J MD
JACKSON
MS
00673391
1932407947
GANDY, JESSICA C FNP
HATTIESBURG
MS
02422713
1366851321
GANDY, SHAWNTA NP
RIDGELAND
MS
00660007
1427190750
GANDY, STEPHEN R DMD
JACKSON
MS
06230860
1992092548
GANGADHARA, SHREYAS MD
JACKSON
MS
07507590
1508154501
GANN, KATIE M CFNP
HOUSTON
MS
07827741
1750789863
GANN, SHELIA D FNP
TUPELO
MS
107
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00126058
1649227745
GANNAWAY, ROBERT A MD
CRYSTAL SPRINGS
MS
07208552
1508187162
GANPOT, SALLYANN J MD
MOUND BAYOU
MS
03505015
1255563771
GANT, LISA M FNP
MERIDIAN
MS
05772715
1013110857
GANTZ-PANNEL, SARAH K DO
BATESVILLE
MS
00120271
1508870049
GARBO, JOE P
BROOKHAVEN
MS
00126007
1053322842
GARCIA, NOEL V MD
TUPELO
MS
02453511
1992067664
GARDNER, AMY L DMD
HATTIESBURG
MS
01839034
1750407573
GARDNER, IAN R MD
LAUREL
MS
01679741
1447450622
GARDNER, JENNIFER R DO
OXFORD
MS
02638842
1043500739
GARG, PADMA P MD
JACKSON
MS
06530271
1275811168
GARG, PARVESH M MD
JACKSON
MS
07801363
1316175573
GARLA, VISHNU V MD
JACKSON
MS
00112780
1659444651
GARNER, BEVERLY A
MACON
MS
06231595
1982913729
GARNER, JESSICA A CFNP
MIZE
MS
07901327
1104952225
GARNER, JUSTIN M MD
COLUMBUS
MS
00134255
1225451842
GARNER, MATTHEW L PA-C
TUPELO
MS
07823203
1811158181
GARNER, RACHEL C MD
TUPELO
MS
00122194
1124017546
GARNER, SHUNDA L MD
JACKSON
MS
00660377
1396853701
GARNER, TERRY L DMD
POPLARVILLE
MS
07720835
1982921391
GARNER, TRACE N MD
JACKSON
MS
09684292
1306911797
GARNER-KUADA, CATHERINE D MD
CANTON
MS
01034591
1295963007
GARRETT, CYNTHIA C MD
MADISON
MS
05878708
1023357274
GARRETT, DONALD J NP
CANTON
MS
09322378
1598779621
GARRETT, JENNIFER H MD
CORINTH
MS
00104005
1184844466
GARRETT, KELLYE B NP
BOONEVILLE
MS
09400546
1528422763
GARRETT, MARCIA P FNP
BATESVILLE
MS
05773334
1275820847
GARRIGA, BRANDON P MD
COLUMBUS
MS
01755393
1073630307
GARRIS, BRANDI R ACNP
LAUREL
MS
108
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08226071
1316984149
GARRISON, ANDREA G MD
TUPELO
MS
06332225
1427421528
GARRISON, KRISTIN C FNP-C
NEW ALBANY
MS
00064953
1376554311
GARROTT, ANDY A DMD
BATESVILLE
MS
00014426
1982664256
GARROTT, THOMAS C MD
OCEAN SPRINGS
MS
00900506
1598016701
GARSTECKI, ALLISON A
PASCAGOULA
MS
03858378
1598016701
GARSTECKI, ALLISON A PA-C
PASCAGOULA
MS
00110034
1366592990
GARTMAN, TAMELA D DO
PASCAGOULA
MS
07951357
1811289564
GASKIN, SHERRY L NP
TUPELO
MS
04383309
1598043143
GASPARD, BRYAN MD
JACKSON
MS
02700217
1275903684
GATES, BRIAN K NP-C
JACKSON
MS
00660331
1194938126
GATEWOOD JR, HIRIAM A DMD
JACKSON
MS
03652214
1417153263
GATEWOOD, JAMES B MD
PASCAGOULA
MS
00660116
1073611620
GATEWOOD, JOSEPH C
CLINTON
MS
00660325
1992830715
GATEWOOD, ROBERT S DMD
JACKSON
MS
00011086
1366458119
GATEWOOD, RONALD W
LAUREL
MS
00053869
1407938368
GATLIN, ALAN D MD
BILOXI
MS
05420520
1932111234
GATLIN, DEBORAH E MD
GULFPORT
MS
06300723
1730387366
GATLIN, JOSEPH L MD
JACKSON
MS
01935855
1669722336
GATLIN, KAREN E GNP-B
HATTIESBURG
MS
02123058
1881846681
GATWOOD, LISA B FNP
HATTIESBURG
MS
00116155
1144285420
GAUDET, JOHN W MD
HATTIESBURG
MS
04931327
1275766396
GAUTAM, SAMIR C MD
NATCHEZ
MS
06727534
1467551465
GAUTIER, KENNETH B MD
BATESVILLE
MS
08101023
1265812424
GAVIN, BRENDA F NP
BILOXI
MS
00113967
1164464681
GAY, HANNAH D MD
JACKSON
MS
00110773
1922030659
GAYMES, CHARLES H
JACKSON
MS
00123507
1811912298
GBEMUDU, EDWARD I MD
OLIVE BRANCH
MS
00120737
1538113899
GEBHART, LELAND D MD
JACKSON
MS
109
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00019590
1114036290
GEER, DAVID A M.D.
MERIDIAN
MS
07274365
1073696977
GEHRKE, GLENN A MD
OXFORD
MS
03383263
1194709568
GEISINGER, KIM R MD
JACKSON
MS
00116304
1194725374
GEISSLER, WILLIAM B MD
JACKSON
MS
05923243
1013992890
GELFORD, BRENDON L MD
TUPELO
MS
05230539
1578763793
GENDI, SALWA M MD
JACKSON
MS
09158533
1982950911
GENERAL, TIFFANY C MD
CORINTH
MS
07059503
1689993644
GENTCHEV, LYNDA I MD
HATTIESBURG
MS
05489238
1659477693
GENTRY, GARY D APRN
GULFPORT
MS
04753519
1568756252
GENTRY, JAMES D MD
LOUISVILLE
MS
06335619
1952575193
GENTRY, SUSAN E FNPC
WIGGINS
MS
00112116
1538178777
GEORGE, ANDREW MD
ROLLING FORK
MS
01456046
1881606440
GEORGE, JESSIE A MD
JACKSON
MS
05836331
1720453673
GEORGE, KHALILAH C FNP
GRENADA
MS
04478370
1659383297
GEORGE, MATTHEW K MD
JACKSON
MS
00203711
1194768242
GEORGE, RICHARD W FPMHN
HATTIESBURG
MS
03400853
1518299213
GERALD, KARLA A
BROOKHAVEN
MS
06805392
1588607329
GERMAIN, GERARD F MD
HATTIESBURG
MS
09134590
1265795678
GERMANY, DANA M NP-C
FLOWOOD
MS
00660347
1811098999
GERRETS JR., TOM F DMD
JACKSON
MS
00016243
1215947411
GERSH, HARVEY A MD
HATTIESBURG
MS
00787321
1033475827
GERSHON, RUTH K MD
JACKSON
MS
05659345
1609250687
GHADRI, NAJIB DDS M
SOUTHAVEN
MS
00118385
1568489417
GHAEMMAGHAMI, NOSRATOLLAH MD
JACKSON
MS
00053580
1568423697
GHAFFARI, BITA MD
BAY ST LOUIS
MS
02027721
1497049852
GHAFOOR, HAFIZ U MD
HATTIESBURG
MS
00127062
1255323663
GHANDOUR, OMAR F
SOUTHAVEN
MS
04189549
1063679512
GHERE, MARY C MD
JACKSON
MS
110
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125777
1174588834
GHOLSON, JENNIFER D MD
SUMMIT
MS
00579753
1649481797
GHOSHEH, BASHAR Z MD
FLOWOOD
MS
04254848
1528477692
GIANG, ANH M OD
MADISON
MS
02982352
1538173513
GIANOLA, COURTNEY M DMD
HATTIESBURG
MS
00126504
1831131671
GIAROLI, EDWARD L MD
TUPELO
MS
02322236
1891089298
GIBBENS, JACOB D MD
JACKSON
MS
01030384
1225202864
GIBBONEY, WILLIAM B NP-C
GULFPORT
MS
04453501
1851765226
GIBBONS, SARA R NP
WEST POINT
MS
09556850
1558784975
GIBBS, SHANNON L FNP-C
MERIDIAN
MS
02408898
1104074210
GIBBS, TRACI L NP
MERIDIAN
MS
00125790
1376520924
GIBSON III, GARY L MD
MERIDIAN
MS
04735364
1477941870
GIBSON, ANGELA D CFNP
RULEVILLE
MS
09853301
1427337765
GIBSON, BRIAN C NP
HATTIESBURG
MS
00116314
1881797439
GIBSON, DON A M.D.
RICHLAND
MS
00688241
1730231929
GIBSON, GAIL G CFNP
CLARKSDALE
MS
03554561
1366806234
GIBSON, GEOFFREY D DO
JACKSON
MS
00115551
1538278734
GIBSON, LARRY
NATCHEZ
MS
00125987
1982639779
GIBSON, MARY W CNP
JACKSON
MS
00119640
1659366854
GIBSON, MICHELLE J MD
JACKSON
MS
06754831
1457741407
GIBSON, NICHOLAS R PAC
PASCAGOULA
MS
06522813
1851688436
GIBSON, SCOTT O MD
JACKSON
MS
00124072
1497767370
GIBSON, W HARRY
MERIDIAN
MS
00122649
1902940026
GIBSON-MCKEE, LISA T MD
JACKSON
MS
00114253
1376584052
GIFFIN, ROBERT L MD
VICKSBURG
MS
07606762
1306839345
GIGER, JERRI L MD
OLIVE BRANCH
MS
00660295
1669523379
GILBERT, BUFORD O DMD
JACKSON
MS
02437318
1346402617
GILBERT, DIANA C MD
LUCEDALE
MS
00060470
1912080748
GILBERT, MARK W DDS
OLIVE BRANCH
MS
111
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08386521
1891981478
GILBERT, SUSAN A FNP
SOUTHAVEN
MS
00114427
1225099922
GILDER, DAVID M MD
YAZOO CITY
MS
00121180
1710913975
GILES, JR., HENRY W
JACKSON
MS
06207069
1639258411
GILICH, JOHNEEN E OD
PICAYUNE
MS
00660267
1811102155
GILILLAND, ROBERT T DMD
SALTILLO
MS
02704891
1194920389
GILL, NATHAN S DO
VICKSBURG
MS
08759078
1720303266
GILLELAND, MEGHAN D MD
COLUMBUS
MS
00011695
1366445520
GILLESPIE III, WILLIAM M MD
COLUMBUS
MS
00016240
1871503086
GILLESPIE JR, HILTON L
HATTIESBURG
MS
05020034
1124117171
GILLESPIE, GEORGE E MD
HATTIESBURG
MS
00110684
1093751232
GILLESPIE, JAMES B M.D.
GREENVILLE
MS
00660119
1164636205
GILLESPIE, JOHN P DMD
JACKSON
MS
03286586
1386893717
GILLESPIE, LEIGH NP
MERIDIAN
MS
06387393
1154314110
GILLESPIE, TIMOTHY G MD
OLIVE BRANCH
MS
04583277
1871943332
GILLETT, GRANT DMD
PASCAGOULA
MS
04321325
1720217367
GILLIAM, DAVID E MD
MERIDIAN
MS
00110281
1053346130
GILLIAM, LARRY S MD
HATTIESBURG
MS
01158792
1104253699
GILLILAND, ASHLEY C ANP
TUPELO
MS
00110162
1902881899
GILLILAND, DAVID H MD
TUPELO
MS
09357761
1538570361
GILMER, DANIEL L MD
JACKSON
MS
09225800
1477706323
GILMER, HEATHER CFNP
LOUISVILLE
MS
02437542
1144517541
GILMORE, APRILE C MD
HATTIESBURG
MS
07776201
1477560050
GILMORE, JAMES C MD
CORINTH
MS
00118874
1194040873
GILMORE, MELANIE FNP
MERIDIAN
MS
07871844
1518009943
GINN, KATHRYN A FNP
MCCOMB
MS
00116526
1538255815
GIOE, SCOTT M MD
GULFPORT
MS
00112115
1023121555
GIPSON IV, WALTER E MD
PICAYUNE
MS
07754793
1164616058
GIPSON, HELEN D NP
JACKSON
MS
112
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04603708
1740201078
GIPSON, MICHAEL J MD
TUPELO
MS
01233807
1528068061
GIPSON, VETRA MD
OXFORD
MS
08255711
1851405369
GIRI, SHANKAR P MD
JACKSON
MS
03038061
1578522934
GIRNYS, RAYMOND P MD
GREENWOOD
MS
00122601
1992893911
GIROD, WESLEY G MD
HATTIESBURG
MS
05752310
1952574048
GIST, GAVIN G MSN
CLARKSDALE
MS
03570021
1396907655
GIVEANS, PAMELA L NP
GULFPORT
MS
00117509
1558422576
GIVENS, RODERICK C MD
NATCHEZ
MS
03756745
1821099482
GIVENS-BOLES, RHONDA CFNP
GREENWOOD
MS
00123468
1366401465
GLADNEY, CHERYL L MD
BROOKHAVEN
MS
08909216
1124042668
GLANTZ, SANFORD MD
COLUMBIA
MS
02106036
1124067384
GLASGOW, ANN FNP
OXFORD
MS
00116480
1316913783
GLASGOW, THOMAS S
OXFORD
MS
04932852
1891135240
GLASS, ANDREW F MD
JACKSON
MS
08620367
1710422860
GLASS, KELLYE M NP
PONTOTOC
MS
00010502
1689684805
GLAZE, ARTHUR L MD
HATTIESBURG
MS
05103781
1568664266
GLEASON, MICHAEL N MD
JACKSON
MS
09375393
1215133731
GLEASON, SARA H MD
JACKSON
MS
09370254
1780729665
GLEASON, SHERRY S CFNP
FLOWOOD
MS
09936303
1730435462
GLENDYE, CAROLYN K MD
JACKSON
MS
08237869
1982612164
GLENN, CLYDE E MD
RIDGELAND
MS
00122327
1972579050
GLENN, FRANCINE
COLUMBUS
MS
04251733
1376920934
GLENN, TAMARA T MD
JACKSON
MS
00014803
1457450058
GLICK, CHRISTINA
FLOWOOD
MS
00501056
1245274281
GLISSON, JAMES K MD
CORINTH
MS
08632351
1184912024
GLOVER IV, MITCHELL O MD
MERIDIAN
MS
03020509
1356638845
GLOVER, CHRISTINA C MD
JACKSON
MS
03001591
1215367230
GLOVER, HILARY NP
IUKA
MS
113
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00016354
1073725933
GLOVER, JEFFREY H MD
JACKSON
MS
06887820
1598911646
GLOVER, SARITA J FNP
LEXINGTON
MS
00017574
1750386488
GLYNN, MARGARET M MD
IUKA
MS
00122303
1407944499
GNAM III, EDWARD C MD
FLOWOOD
MS
05172764
1669747184
GOAN, KARI J DO
COLUMBUS
MS
00114112
1477565166
GOBER, GREGG A
GREENVILLE
MS
05956046
1073797338
GODBOLD, JENNIFER S FNP
JACKSON
MS
09588315
1073721544
GODWIN, ROBBIE B MD
COLUMBUS
MS
03356336
1366607749
GOEBEL, MICHAEL A MD
HATTIESBURG
MS
00015644
1023115334
GOEL, DINESH K MD
JACKSON
MS
00118231
1548219082
GOEL, PARVESH K MD
MADISON
MS
01472797
1619145539
GOFF, KRISTY D DMD
JACKSON
MS
05082511
1760473672
GOINES, BONNIE R FNP
CHOCTAW
MS
09238258
1689831844
GOLDBERG, RICHARD A DO
GREENWOOD
MS
00750713
1356727051
GOLDEN, FRANKLIN S PMHNP
LAUREL
MS
00116646
1831242627
GOLDEN, JOE A MD
JACKSON
MS
00124064
1831193440
GOLDEN-SIMMONS, ANITA F FNP
SENATOBIA
MS
09689876
1184989139
GOLDMAN, EVGENY MD
JACKSON
MS
00087885
1073532693
GOLDRING, GLENN I
SENATOBIA
MS
04586367
1376950204
GOLDSMITH, BRANDON M MSN
JACKSON
MS
07854358
1477748648
GOLDSMITH, SHANNON L DO
ELLISVILLE
MS
00014887
1285661413
GOLDSTEIN, LAWRENCE S MD
JACKSON
MS
03886877
1568562742
GOMBAKO AMOS, LOUISE A MD
MCCOMB
MS
01829362
1013352343
GOMEZ DE TAVAREZ, BRUNEL TERESA MD
AMORY
MS
03980274
1871806679
GOMEZ, ENRIQUE MD
MERIDIAN
MS
09303041
1669784385
GOMEZ, FERNANDO MD
JACKSON
MS
05273041
1740220326
GOMEZ, ROSA A MD
SOUTHAVEN
MS
00121292
1033139555
GOMEZ-SANCHEZ, CELSO E MD
JACKSON
MS
114
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05504096
1912928086
GONDWE, JUSTICE A MD
GRENADA
MS
07353371
1386873701
GONG, STEPHANIE H MD
MADISON
MS
02389071
1184910200
GONNALAGADDA, SWATHI MD
JACKSON
MS
09338860
1669635785
GONZALES, MICHAEL RAYMUND C MD
HATTIESBURG
MS
03731244
1205808342
GONZALEZ FERNANDEZ, FEDERICO MD
JACKSON
MS
09904243
1801023809
GONZALEZ, MARIA F MD
JACKSON
MS
00111737
1275547564
GOOCH, KENNETH L MD
HATTIESBURG
MS
02157500
1356680573
GOODE, COURTNEY D ANP
SOUTHAVEN
MS
06474210
1164573515
GOODFELLOW, KEITH G MD
GULFPORT
MS
00736037
1952569261
GOODIN, AMY M PA
MERIDIAN
MS
09289510
1952383812
GOODIN, SONYA K FNP
LOUISVILLE
MS
00660220
1063427961
GOODLOE, ERIKA L DMD
CANTON
MS
05003535
1023468659
GOODMAN, AMBRIE P DMD
NETTLETON
MS
00012338
1285616144
GOODMAN, BARBARA B MD
MERIDIAN
MS
00117500
1336247089
GOODMAN, PERRY J MD
MERIDIAN
MS
07303017
1184652489
GOODSON, KRISTI H
JACKSON
MS
08003829
1669618302
GOODWIN FERNANDEZ, AMINA N MD
MERIDIAN
MS
00755091
1285616870
GOODWIN, ANDREA D MD
MERIDIAN
MS
00114550
1447294590
GOODWIN, ELIZABETH H FNP
FLOWOOD
MS
00064011
1902992043
GOODWIN, KEN DMD
BOONEVILLE
MS
00387876
1255725818
GOOGE, AMBER B MD
JACKSON
MS
05380572
1124480215
GOOGE, BENJAMIN J MD
JACKSON
MS
00018487
1134139355
GOOGE, JR., JAMES H
NEW ALBANY
MS
00660355
1295883650
GOOLSBY SR, JOHN M DMD
CLINTON
MS
00118596
1780604819
GORDON JR, FELIX MD
JACKSON
MS
08505248
1346349487
GORDON, CATHERINE J MD
JACKSON
MS
01674360
1265400485
GORDON, DEREK M MD
PASCAGOULA
MS
04458061
1124010640
GORDON, GARY G DO
MERIDIAN
MS
115
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06527227
1215145222
GORDON, JESSICA DO
HATTIESBURG
MS
04124592
1811076938
GORDON, KYLE F MD
JACKSON
MS
08723392
1427018613
GORDON, MAXIE L MD
JACKSON
MS
09582705
1235243569
GORDON, RITA L FNP
VICKSBURG
MS
00660296
1932280567
GORDY, FRANCES M DMD
JACKSON
MS
04851204
1124167325
GORDY, MARY A CFNP
JACKSON
MS
00112415
1205802584
GORE, EDWARD K
HOUSTON
MS
04626886
1770760357
GOREE, SANTRISE B MD
GULFPORT
MS
02855367
1588984744
GORETH, MICHELLE B CPNP
JACKSON
MS
00010048
1699856419
GORMAN, DOUGLAS E MD
JACKSON
MS
00013935
1366562431
GORMAN, RICHARD J DO
BILOXI
MS
01082827
1972572683
GORTON, SIDNEY C MD
BELZONI
MS
00014079
1528037116
GORTON, WALTER M
BELZONI
MS
07501378
1548608128
GOSS, JENNIFER L CFNP
GRENADA
MS
09801514
1740410661
GOUGH DAVIS, NORA C FNP
SHAW
MS
01281539
1992782544
GOWDY JR, OTIS MD
MERIDIAN
MS
00628001
1376981464
GOWDY, KELLY B NP
SOUTHAVEN
MS
00064672
1831209204
GOZA, JR., HARRY E
HATTIESBURG
MS
06725319
1912294224
GRABMILLER, SARAH DO
ABERDEEN
MS
09822061
1871933291
GRADY, JOHN MD
GULFPORT
MS
08603769
1447451349
GRAEBER, ANGELA MD
JACKSON
MS
00018496
1558461459
GRAEBER, MICHAEL C MD
JACKSON
MS
00119381
1427041664
GRAFF, JUSTIN C
TUPELO
MS
00013561
1568496669
GRAFTON, JULIAN K MD
LAUREL
MS
00115226
1205831666
GRAHAM, BOBBY L
JACKSON
MS
00126157
1558462218
GRAHAM, ERIC J MD
GULFPORT
MS
01706241
1144517715
GRAHAM, JACOB M MD
JACKSON
MS
09435889
1851599211
GRAHAM, JEREMY R
MERIDIAN
MS
116
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05108802
1225096860
GRAHAM, JOSEPH A DO
GULFPORT
MS
00116274
1275515843
GRAHAM, LEON J MD
MERIDIAN
MS
00087908
1164572848
GRAHAM, PHILIP R OD
PONTOTOC
MS
00122207
1518074517
GRANADOS, JAVEL MD
SENATOBIA
MS
00660123
1124248240
GRANBERRY, DENNIS L DDS
HATTIESBURG
MS
00017026
1023030426
GRANGER, WESLEY D M.D.
RIDGELAND
MS
01578795
1174861058
GRANT, CARRIE J PA-C
OCEAN SPRING
MS
07900868
1750740965
GRANT, DANA L FNP
CALHOUN CITY
MS
05025008
1881759702
GRANT, DANA R MD
JACKSON
MS
00115825
1356323190
GRANT, FREDRICK Y MD
MERIDIAN
MS
03557871
1487909859
GRANT, JALARNA J MD
MOUND BAYOU
MS
04774359
1821472267
GRANT, JARED A OD
SENATOBIA
MS
05727030
1093970733
GRANT, MARY J
SOUTHAVEN
MS
06975501
1437558061
GRANT, MICAH A FNPC
COLUMBUS
MS
00122104
1073597092
GRANT, VINCENT L MD
PICAYUNE
MS
00116939
1710092077
GRANT, WALTER K MD
GULFPORT
MS
00656244
1851570006
GRANT-SPENCER, TELITHA K MD
SEBASTOPOL
MS
00122355
1225048291
GRANTHAM, WILLIAM M M.D.
CLINTON
MS
01137371
1720441504
GRANTIER III, RICHARD L MD
JACKSON
MS
08036027
1396943007
GRAVELL, GREGORY J MD
MERIDIAN
MS
05981257
1164483814
GRAVERSEN, CATHERINE H MD
HATTIESBURG
MS
04274856
1932233392
GRAVERSEN, JENS F
LAUREL
MS
06875744
1154540359
GRAVES, EMILY T MD
OXFORD
MS
00060223
1760493134
GRAVES, JAMES G DMD
SENATOBIA
MS
01678770
1336237833
GRAVES, KAREN L APRN
MCCOMB
MS
08202361
1215337746
GRAVES, KATHY H NP
YAZOO CITY
MS
01301804
1891702148
GRAVES, MATTHEW L MD
JACKSON
MS
00119507
1528140720
GRAVES, THOMAS L MD
GULFPORT
MS
117
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09337094
1154629178
GRAY, ASHLEY D CRNP
ENTERPRISE
MS
03486259
1669889457
GRAY, HANNAH L NP-C
MERIDIAN
MS
04358321
1891878005
GRAY, JERMAINE E MD
JACKSON
MS
01689087
1518988328
GRAY, JIM MD
FLOWOOD
MS
00126220
1043326929
GRAY, LEIGH L
BROOKHAVEN
MS
00119529
1295727766
GRAY, LESLIE B MD
BILOXI
MS
06673726
1518980051
GRAY, PHILLIP A OD
IUKA
MS
00087882
1841254570
GRAY, PHILLIP H OD
IUKA
MS
04034761
1811942014
GRAY, ROBERT B MD
HATTIESBURG
MS
00125565
1346357498
GRAYSON, JENNIFER L
BILOXI
MS
04208026
1437169521
GRAYSON, WAYNE E MD
POPLARVILLE
MS
02256371
1922214923
GREAR, BENJAMIN J MD
SOUTHAVEN
MS
07953729
1891795688
GREASER, RAYMOND D MD
OXFORD
MS
00123921
1992881882
GRECO, BETHANY CFNP
CALHOUN CITY
MS
00119323
1861495111
GREEN JR, JAMES R
MERIDIAN
MS
00123059
1881671931
GREEN, ANNIE B
HATTIESBURG
MS
07431342
1548633761
GREEN, BRIDGETT T NPC
OXFORD
MS
01755582
1174843742
GREEN, CHARLOTTE R PMHNP
TUPELO
MS
09586759
1982644597
GREEN, DANNY L OD
JACKSON
MS
01131260
1861846313
GREEN, DAVID L MD
JACKSON
MS
07605864
1073719803
GREEN, EDWARD D MD
JACKSON
MS
07800551
1730439407
GREEN, ERIN M NP
MADISON
MS
01873751
1982057345
GREEN, FLORA K NP
JACKSON
MS
02851847
1376848077
GREEN, GACHAVIS M DPM
HATTIESBURG
MS
03657510
1154761500
GREEN, JOHN F MD
JACKSON
MS
05207521
1114311446
GREEN, LAKEISHA C PMHNP
JACKSON
MS
07608845
1578875894
GREEN, LATONYA T MD
SOUTHAVEN
MS
09282029
1235472697
GREEN, RODERICK T PMHNP
WHITFIELD
MS
118
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00286055
1447661533
GREEN, RYAN J DO
JACKSON
MS
07358266
1376504357
GREEN, STEPHANIE FNP
PURVIS
MS
08089843
1720373335
GREEN, TORRANCE T MD
JACKSON
MS
05775706
1629514286
GREEN, TRACIE NP
PASCAGOULA
MS
08800015
1083040562
GREENE, AMANDA B FNP
LEXINGTON
MS
00117668
1417964081
GREENE, MICHAEL L D.O.
RICHLAND
MS
08827004
1336431436
GREENFIELD, BRAD J MD
PASCAGOULA
MS
04125056
1215249131
GREENHAW, BRADLEY N MD
TUPELO
MS
00012364
1659449361
GREENHAW, DAVID N MD
BOONEVILLE
MS
02729868
1689981078
GREENLEAF, CHRISTOPHER E MD
JACKSON
MS
07103564
1780087304
GREER, ANITA S NP
KOSCIUSKO
MS
00064055
1699856591
GREER, CHARLES E DDS
HATTIESBURG
MS
04856353
1558761668
GREER, CHASSITY W FNP
BYHALIA
MS
00124371
1285600395
GREER, CURTIS L
TUPELO
MS
03181214
1265753172
GREER, JENNIFER L FNP-C
PORT GIBSON
MS
06580370
1912386194
GREER, ROBERT A MD
JACKSON
MS
00123320
1922080522
GREER, WILLIE E MD
CHOCTAW
MS
06937269
1295788040
GREESON, CHARLES MD
CENTREVILLE
MS
02678069
1952523607
GREGG, FREDERICK O
HATTIESBURG
MS
00119787
1194758854
GREGG, KATHARINE T MD
JACKSON
MS
01272323
1649463050
GREGG, TINA M NP
FLOWOOD
MS
00120813
1639105794
GREGORY GORDON MD PLLC
FLOWOOD
MS
00120813
1639105794
GREGORY GORDON MD PLLC
JACKSON
MS
00880009
1134210123
GREGORY, JOSEPH E OD
OCEAN SPRINGS
MS
00014525
1477512846
GREGORY, RAY N
CORINTH
MS
03208069
1770779332
GRELLE, KATHERINE W MD
MERIDIAN
MS
05109745
1861479529
GREMILLION, AVIT J MD
BILOXI
MS
00128291
1780899922
GRENFELL III, RAYMOND F MD
JACKSON
MS
119
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00017558
1851309165
GRENFELL, RAYMOND F MD
JACKSON
MS
05822327
1689096505
GRESSETT, WENDY D NP
COLLINSVILLE
MS
01888564
1114214038
GREWAL, GAGANDEEP S MD
HATTIESBURG
MS
01101250
1396904090
GREWAL, HARMANJOT MD
HATTIESBURG
MS
00114214
1871624627
GRIENER, THAYNE C MD
PASCAGOULA
MS
00660385
1336168111
GRIFFIN JR, JOHN J DMD
COLUMBUS
MS
05987012
1518943703
GRIFFIN JR, RICHARD W MD
HATTIESBURG
MS
03300361
1720274327
GRIFFIN, JAMES W MD
NEW AUGUSTA
MS
02682506
1609002500
GRIFFIN, JENNIFER K MD
LUCEDALE
MS
03083313
1770771743
GRIFFIN, JOSHUA G MD
COLUMBUS
MS
04876515
1619188026
GRIFFIN, KAISHA
JACKSON
MS
05875099
1124355086
GRIFFIN, LAURA A MD
JACKSON
MS
07754391
1558688416
GRIFFIN, LEPERCIVAL D MD
FOREST
MS
04506555
1386781151
GRIFFIN, MANDA S FNP
HOULKA
MS
03189289
1518194265
GRIFFIN, MARY A NP
PELAHATCHIE
MS
04539788
1720262579
GRIFFIN, MEREDITH K MD
AMORY
MS
08123322
1487673406
GRIFFIS, KATHERINE P NP
GULFPORT
MS
04175796
1518097815
GRIFFITH, CAMERON S MD
HATTIESBURG
MS
00126499
1205891975
GRIFFITH, CHARLES R MD
PURVIS
MS
07627599
1588735617
GRIFFITH, CHRISTOPHER M M.D.
SOUTHAVEN
MS
02575795
1689977027
GRIFFITH, JENNIFER M NP
GULFPORT
MS
05089351
1760542138
GRIFFITH, KEVIN L MD
GULFPORT
MS
05451560
1619007440
GRIFFITH, MARK PAC
BILOXI
MS
04252075
1578561262
GRIMES, BRENT A NP
CORINTH
MS
00111800
1598877805
GRIMM, LEANDER M MD
SOUTHAVEN
MS
08631263
1134350465
GRINDLEY, NATOYA N MD
LUCEDALE
MS
06085766
1952406589
GRISHAM, JENNIFER L MD
TUPELO
MS
06335232
1699921957
GRISSOM, JASON S DMD
ACKERMAN
MS
120
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125530
1023050960
GRISWOLD, RICHARD D
TUPELO
MS
00115070
1609878560
GROFF, GARY H MD
PASCAGOULA
MS
06770035
1184902389
GROGAN, KALEY G NP
JACKSON
MS
01787000
1942640180
GRONDIN, JEFFREY J MD
JACKSON
MS
00064972
1144351792
GROSS II, THOMAS G DMD
CARTHAGE
MS
07977525
1336119577
GROSS, STUART R MD
FLOWOOD
MS
05783828
1922546589
GROVE, AMY E ACNP
JACKSON
MS
07985779
1205997251
GROW, CHELSEA R DO
GULFPORT
MS
06953001
1629341649
GRUBBS, AMY L NP
HATTIESBURG
MS
00115028
1154431351
GRUICH, JR., MITCHELL J MD
BILOXI
MS
06082548
1528339918
GRUNDY, LORI L PA-C
PETAL
MS
06432292
1912221946
GRUNES, DIANNE E MD
JACKSON
MS
04289079
1942699988
GRUZINSKAS, BETH G NP
GULFPORT
MS
07359894
1235164286
GUBIN, DAVID A MD
SOUTHAVEN
MS
00115424
1386682011
GUEDON, DUNCAN F MD
NATCHEZ
MS
02438088
1801177985
GUERINGER, LLOYD J NP
BAY ST LOUIS
MS
00124195
1629128517
GUEST, DARYL P MD
STARKVILLE
MS
00015350
1831150838
GUICE, III, CHARLES E MD
HATTIESBURG
MS
00123945
1760492805
GUICE, JOHN M
HATTIESBURG
MS
00113657
1316959018
GUIDRY, SCOTT P MD
HATTIESBURG
MS
05223367
1396771366
GUILD, CAMERON S MD
JACKSON
MS
00930233
1255654778
GUILD, DONALD G MD
PHILADELPHIA
MS
04783224
1093123275
GUIN, MICHAEL B FNP
MERIDIAN
MS
00120500
1013098995
GULANIKAR, AVINASH C M.D.
FLOWOOD
MS
00120761
1770676975
GULANIKAR, VINITA
JACKSON
MS
09071764
1477718658
GULATI, SALIL MD
JACKSON
MS
03458379
1710327960
GULF COAST PEDIATRIC DENTISTRY LLC
GULFPORT
MS
03458379
1710327960
GULF COAST PEDIATRIC DENTISTRY LLC
BILOXI
MS
121
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06673065
1801067590
GULIK, ANNA M NP
CLARKSDALE
MS
00115106
1841306297
GULLUNG III, WILLIAM H
HATTIESBURG
MS
03773763
1093919839
GUNDY, PAUL D DMD
KOSCIUSKO
MS
00118735
1346289477
GUNN, MARK G MD
OXFORD
MS
02287768
1508113168
GUNN, SUSAN S
UNIVERSITY
MS
04977229
1174937148
GUNTURU, MANASA MD
JACKSON
MS
00053731
1760893689
GUO, YANGLIN MD
JACKSON
MS
06480394
1932150984
GUOTH, PAMELA R MD
OXFORD
MS
00502547
1265640148
GUPTA, AMIT K MD
TUPELO
MS
05205321
1376963132
GUPTA, GEETIKA C MD
JACKSON
MS
00014822
1598769176
GUPTA, KRISHAN K MD
JACKSON
MS
02959257
1013113364
GUPTA, NITIN MD
JACKSON
MS
03709742
1669602603
GUPTA, RAJEEV MD
SOUTHAVEN
MS
03575076
1942466842
GUPTA, RICHA MD
GULFPORT
MS
04703517
1083614317
GUSA JR, WILLIAM E MD
JACKSON
MS
00903298
1750326286
GUTIERREZ, APRIL T
JACKSON
MS
00114543
1043234461
GUTIERREZ, YOLANDA
PASCAGOULA
MS
00121571
1902914088
GUTTI, KUMARI V MD
WINONA
MS
00117369
1770526568
GUYNES, RICHARD D MD
JACKSON
MS
00115044
1962461673
GUYTON, BARNEY J MD
TUPELO
MS
02500077
1699716357
GUYTON, DOUGLAS C MD
JACKSON
MS
04507391
1588640726
GUYTON, THOMAS S MD
OLIVE BRANCH
MS
02238509
1740457365
GUZMAN-ARRIETA, EDGAR MD
HATTIESBURG
MS
09675760
1225178197
GWIN, SHERRY R
PEARL
MS
00125591
1568474294
HABEEB, DANIEL M MD
HATTIESBURG
MS
00115025
1033121785
HABEEB, GEORGE MD
JACKSON
MS
00173095
1063610871
HADDAD, DANY MD
MCCOMB
MS
07934003
1093972929
HADDAD, ELLEN K MD
MCCOMB
MS
122
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125832
1184636847
HADEN, LEIGH A
HATTIESBURG
MS
00124811
1164460101
HADIDI, MOHAMAD F
CLARKSDALE
MS
04931706
1720216955
HADLEY, DEGAIL J DO
CLEVELAND
MS
06456021
1265589030
HAGE FAMILY DENTISTRY
GULFPORT
MS
05623898
1710240916
HAGER JR, KARL J NP
CANTON
MS
00117699
1992716732
HAHN, KENNETH A
GREENVILLE
MS
00018585
1932214640
HAICK, ALEXANDER J MD
JACKSON
MS
00112453
1407837503
HAIDAR, AHMAD A MD
CARRIERE
MS
04552378
1659785202
HAIK, KARLA D DMD
JACKSON
MS
06258755
1225232895
HAILEY, LARRY S DO
MERIDIAN
MS
00706071
1467716860
HAILEY-SHARP, ANNA M MD
JACKSON
MS
04528298
1831295237
HAINES, LESLIE
JACKSON
MS
00126275
1922074228
HAIRE, ANNE DO
TUPELO
MS
00014378
1184603805
HAIRE, WILLIAM C
BATESVILLE
MS
05686800
1871513721
HAIRSTON, BETHANY R
COLUMBUS
MS
08874561
1053737460
HAIRSTON, FRANCES J MD
TUPELO
MS
04771528
1295847432
HAIRSTON, TONYATTA T
MAGEE
MS
00121501
1992782924
HALBROOK, JOHN C MD
MERIDIAN
MS
00115500
1275503104
HALE, GREGORY J MD
OXFORD
MS
04255707
1861605560
HALE, LESLIE R CFNP
ECRU
MS
05955262
1740696434
HALE, TANIKA L DDS
BILOXI
MS
00015836
1790797389
HALE, THOMAS E
HATTIESBURG
MS
07623596
1932145653
HALEY, CHARLES T MD
BATESVILLE
MS
00122448
1730193103
HALFORD, PRICE W
JACKSON
MS
00119820
1952338659
HALINSKI, DAVID M MD
VICKSBURG
MS
00016716
1831106475
HALL JR, DONALD S
VICKSBURG
MS
05250546
1801909916
HALL, ANITA C FNP
LAUREL
MS
02052823
1124240973
HALL, BARRY
JACKSON
MS
123
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00114808
1568534832
HALL, CHARLES E MD
FLOWWOD
MS
00934052
1104876580
HALL, CHRISTOPHER L MD
LUCEDALE
MS
04153563
1700805041
HALL, CLIFFORD T MD
CLARKSDALE
MS
00060002
1336241678
HALL, DANIEL D DMD
EUPORA
MS
09923554
1871518597
HALL, JAMES B
BROOKHAVEN
MS
00011658
1811007313
HALL, JAMES E MD
BROOKHAVEN
MS
07805374
1750554929
HALL, JENNIFER C NNP
MERIDIAN
MS
00660061
1467673764
HALL, JOHN E DMD
HATTIESBURG
MS
05357253
1558521021
HALL, JUSTIN M MD
COLUMBUS
MS
04234769
1962816405
HALL, LASHONDA D APN
OLIVE BRANCH
MS
02476282
1962795815
HALL, LASHUNDRA B NP-C
NEW ALBANY
MS
04573051
1346794260
HALL, LISA M FNP
PONTOTOC
MS
03057378
1851602569
HALL, MELANIE K MD
HATTIESBURG
MS
07271044
1235340225
HALL, MICHAEL E MD
JACKSON
MS
05802031
1902847163
HALL, PATRICIA D NP
GULFPORT
MS
09234892
1952663148
HALL, SAMUEL R DMD
TUPELO
MS
00119678
1255307559
HALL, SHARON V
ABERDEEN
MS
05701873
1841406154
HALL, STEPHANIE MD
RIPLEY
MS
00880003
1811177843
HALL, TODD OD
GREENWOOD
MS
02932795
1699921023
HALL, TRESSIE C OD
BROOKHAVEN
MS
01433224
1689050262
HALL, TREVOR T DMD
LAUREL
MS
00931031
1063746345
HALL, VICKEY M FNP
IUKA
MS
00937242
1003036252
HALL-HILL, TESIA DO
JACKSON
MS
06000736
1447514914
HALLEY, LINDSEY D MD
JACKSON
MS
04474263
1619305687
HALLMARK, CODI NP
TUPELO
MS
07076371
1598709503
HALLSTROM, CRAIG K MD
JACKSON
MS
00115705
1699888628
HALTOM III, J MACK MD
RIDGELAND
MS
00114795
1710965694
HALTOM, JAMES R MD
JACKSON
MS
124
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07200316
1912220237
HAM, AMANDA L ANP
CORINTH
MS
03139011
1518051705
HAMADEH, FERAS MD
VICKSBURG
MS
07181368
1346673191
HAMBY, DAVID E NP
FLOWOOD
MS
07829545
1487766978
HAMILL, TERESA J NP
ABERDEEN
MS
06817082
1073711313
HAMILTON, BRIAN S MD
HATTIESBURG
MS
03802278
1578587523
HAMILTON, GAYLE E NP
JACKSON
MS
07221316
1982801858
HAMILTON, JAMES H MD
JACKSON
MS
09982341
1255742722
HAMILTON, JR, THOMAS B MD
JACKSON
MS
08735535
1881002863
HAMILTON, LAURIE A FNPC
CHOCTAW
MS
00113723
1649240599
HAMILTON, MORRIS R
OXFORD
MS
00125701
1154367837
HAMILTON, ROBERT D
JACKSON
MS
00120620
1639274350
HAMILTON, WILLIAM V DO
MERIDIAN
MS
00114582
1467511717
HAMLIN, MELINDA NP
CORINTH
MS
01839212
1649689548
HAMM, DAYNA FNP
HATTIESBURG
MS
03730749
1699913202
HAMM, MELANIE R PNP
HATTIESBURG
MS
07838781
1639396393
HAMMACK, STEPHEN C MD
FLOWOOD
MS
03986803
1710144571
HAMMACK, TRACEY R NP
BILOXI
MS
02977032
1356616114
HAMMAKER, TERESA NP
BYRAM
MS
07458861
1710180807
HAMMER, LARISSA N DMD
OXFORD
MS
02284820
1396757910
HAMMETT, MICHAEL J M.D.
HATTIESBURG
MS
02228351
1497977920
HAMMOCK, BRIAN A MD
BILOXI
MS
02676031
1598982993
HAMMOND, ROSALIND MD
JACKSON
MS
00115267
1831295807
HAMNER JR, DABNEY J MD
SOUTHAVEN
MS
00016778
1942230800
HAMPTON, HARRIETTE L MD
JACKSON
MS
00118244
1356367452
HAMPTON, JACQUELINE L MD
COLUMBUS
MS
00121716
1740226018
HAMPTON, VICKI L
ELLISVILLE
MS
01972509
1679612212
HAN, AENA D MD
JACKSON
MS
00123126
1689896763
HANCOCK, AMY G NP
YAZOO CITY
MS
125
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06455057
1821120072
HANCOCK, HEATHER A MD
JACKSON
MS
02335836
1518168210
HANCOCK, HEATHER K CFNP
BALDWYN
MS
00113018
1720067994
HANCOCK, JOHN C MD
JACKSON
MS
00934885
1780766238
HAND, DWIGHT E
MERIDIAN
MS
04726013
1225340599
HAND, HOYET A MD
JACKSON
MS
05008582
1689664039
HAND, JOSHUA P MD
RALEIGH
MS
01827278
1396964623
HAND, KAREN E
GULFPORT
MS
00087905
1326196684
HANDY, DEWEY A OD
JACKSON
MS
01759275
1407922867
HANEGAN, SCOTT J DPM
MERIDIAN
MS
00116563
1609818442
HANEY, WILLIAM K
TUPELO
MS
04000084
1104217017
HANKINS, ALISIA C MSN
JACKSON
MS
01604872
1861565293
HANKINS, DANIEL T MD
JACKSON
MS
00012939
1235231606
HANKINS, RANDY R MD
HAZLEHURST
MS
04383354
1275749541
HANN, MATTHEW C MD
GULFPORT
MS
00114485
1720025968
HANNA, SHAHIRA MD
BILOXI
MS
02129009
1407893324
HANS, SARTAJ S MD
JACKSON
MS
08273769
1417182007
HANSEN III, DALE E MD
OLIVE BRANCH
MS
06036231
1043548381
HANSEN, CECILIA DO
JACKSON
MS
06788511
1194089581
HANSEN, DEREK T MD
JACKSON
MS
03984749
1881958270
HANSEN, DORIS MD
JACKSON
MS
07474365
1366762155
HANSEN, LAXMISILPA G MD
OLIVE BRANCH
MS
05705759
1861832255
HANSEN, SPENCER K
BILOXI
MS
08758233
1619214541
HANSON, AMANDA NP
GULFPORT
MS
02984324
1730292798
HANSON, BURNETT M.D.
MCCOMB
MS
03971251
1932511482
HAO, ANNIE Y OD
SOUTHAVEN
MS
09976358
1356464523
HAPWORTH, HUNTINGTON T MD
PASCAGOULA
MS
00372820
1003063959
HAQUE, MONEERA N MD
MERIDIAN
MS
07778850
1720410566
HAQUE, NURUL MD
VICKSBURG
MS
126
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08087751
1205191467
HAQUE, SADIA MD
JACKSON
MS
01825338
1790941490
HARASTY, HEATHER C MD
JACKSON
MS
03652335
1679769491
HARAWAY, ALLEN M MD
JACKSON
MS
07626716
1790876928
HARAWAY, ANGELA S NP
JACKSON
MS
09700016
1154559672
HARBARGER, CLAUDE F MD
JACKSON
MS
03353873
1639519895
HARBARGER, DAVID A DMD
CHOCTAW
MS
00121401
1619984390
HARBIN, ANGEL S CFNP
TUPELO
MS
08708015
1659477891
HARBISON, DANA BIANCA MD
GULFPORT
MS
03301239
1508903626
HARBOUR, KEVIN C MD
TUPELO
MS
06976056
1225290760
HARDEMAN, JAMIE L MD
HATTIESBURG
MS
07926573
1104869148
HARDEMAN, NATASHA N
JACKSON
MS
01957391
1679890552
HARDEN, BAHITI S MD
GREENWOOD
MS
05354579
1629274691
HARDEN, EMILY L DMD
HATTIESBURG
MS
02323888
1861428716
HARDEN, HEATHER J CFNP
MCCOMB
MS
05238246
1154671204
HARDEN, HEATHER S ACNP
GREENVILLE
MS
00015626
1386728152
HARDEN, JEFF MD
GREENWOOD
MS
04508001
1396939542
HARDEN, TED G OD
HATTIESBURG
MS
07421028
1598921892
HARDIN, BRENT M MD
OXFORD
MS
04986562
1295056034
HARDIN, CASSEY R DMD
INDIANOLA
MS
03239875
1669450037
HARDIN, CHARLIE
JACKSON
MS
00017506
1386636140
HARDIN, JAMES R MD
GREENWOOD
MS
08877239
1740360056
HARDIN, KATHLEEN H MD
JACKSON
MS
00110986
1841392784
HARDIN, KIM W CFNP
BLUE MOUNTAIN
MS
08272378
1174902134
HARDIN, PAMELA D NP
MERIDIAN
MS
01522859
1225083942
HARDIN, ROBERT H MD
RIDGELAND
MS
00116524
1144319252
HARDIN, STEPHANIE M NP
HOLLY SPRINGS
MS
00651266
1407838279
HARDIN, WILLIAM G M.D.
SOUTHAVEN
MS
00115108
1942203286
HARDING, ERIC D MD
NEW ALBANY
MS
127
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05179721
1982017315
HARDY, JESSICA L FNP
PHILADELPHIA
MS
09483506
1174636195
HARDY, JOANNA M NP
HATTIESBURG
MS
00015037
1013932490
HARDY, MERRILL D MD
FLOWOOD
MS
02302341
1487808838
HARDY, PAULA R CFNP
COLUMBUS
MS
00118665
1114086584
HARE, LAURA J CFNP
STARKVILLE
MS
01984793
1154351864
HARGETT, RITA FNP
AMORY
MS
05631288
1346429214
HARGROVE, ELAINE FNP
JACKSON
MS
00013566
1609823939
HARKEY, HAYNES L MD
JACKSON
MS
00123984
1124094453
HARKINS, DENISE L MD
JACKSON
MS
07422067
1457376915
HARKINS, DOUGLAS D MD
JACKSON
MS
00121807
1710902390
HARKINS, KIMBERLY MD
JACKSON
MS
00117512
1336151976
HARLESS, STEPHEN L MD
PURVIS
MS
00123655
1245232495
HARMAN, FRANCIS E MD
MERIDIAN
MS
00017183
1073554275
HARMON, EDWIN P MD
JACKSON
MS
02280263
1215926423
HARPER, JANAY L DPM
CANTON
MS
07907550
1568911527
HARPER, JENNA M NP
MERIDIAN
MS
09302334
1104853803
HARPER, JULIE G MD
OXFORD
MS
08281817
1922068584
HARPER, TAMARA V
GULFPORT
MS
00015590
1568502714
HARPER, WILLIAM DO
GREENWOOD
MS
00018120
1225145212
HARPER, WILLIAM K MD
JACKSON
MS
00013342
1871575852
HARRELL, BERNARD G DO
FOREST
MS
05223768
1508060724
HARRELL, JARROLD A OD
MCCOMB
MS
00426375
1265505853
HARRELL, KIMBERLY D FPMHN
JACKSON
MS
00572861
1285838417
HARRELL, KIMBERLY F OD
MCCOMB
MS
07703269
1760785257
HARRELSON, ROBIN F FNP
TUPELO
MS
00123356
1184614984
HARRIER, HARVIE D MD
NATCHEZ
MS
00880221
1750350070
HARRINGTON, BETHANY G
POPLARVILLE
MS
05438767
1346337920
HARRINGTON, CYNTHIA CFNP
MERIDIAN
MS
128
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00010816
1093708232
HARRINGTON, DONNA MD
TUPELO
MS
03656204
1548600612
HARRINGTON, JORDAN H NP
MCCOMB
MS
00633561
1275922502
HARRINGTON, MARILYN N CNP
JACKSON
MS
00060154
1114050440
HARRINGTON, MARY T DMD
JACKSOM
MS
00101399
1649420084
HARRIS, ALISON S CFNP
AMORY
MS
05474323
1104076645
HARRIS, ASHLEY W MD
TUPELO
MS
07623077
1992156863
HARRIS, BRITTANY FNP
CLARKSDALE
MS
08928061
1710935671
HARRIS, CAROL D MD
MERIDIAN
MS
00060283
1750379731
HARRIS, JAMES H DMD
HATTIESBURG
MS
06132829
1275576233
HARRIS, JOE A
PURVIS
MS
00121627
1639188303
HARRIS, JOE T MD
OXFORD
MS
07825776
1811168578
HARRIS, LORI C CFNP
SALTILLO
MS
06021032
1861522807
HARRIS, MARY E NP
BAY ST LOUIS
MS
04959238
1184944290
HARRIS, MATTHEW J DMD
HORN LAKE
MS
03152720
1669662292
HARRIS, PORTIA M MD
HATTIESBURG
MS
05133772
1235553462
HARRIS, REBECCA E CFNP
WIGGINS
MS
00110609
1215011846
HARRIS, ROBERT B MD
MCCOMB
MS
00120177
1982641189
HARRIS, ROBERT L MD
JACKSON
MS
00660273
1801186770
HARRIS, STEPHANIE J DMD
WHITFIELD
MS
06805206
1316373038
HARRIS, TERESA G NP
TUPELO
MS
07100010
1427282599
HARRIS, TONI T MSN
JACKSON
MS
03533293
1285853002
HARRIS, TRISTEN A PA
JACKSON
MS
00123283
1912058520
HARRIS, WILLIAM J MD
JACKSON
MS
00119606
1902874571
HARRIS, WILLIAM K MD
BYRAM
MS
07474202
1659660512
HARRIS-COCROFT, GWENDOLYN NP
COLLINS
MS
00126134
1285619163
HARRISON JR, NEWT P MD
TUPELO
MS
00118971
1497702302
HARRISON, DAVID L MD
LAUREL
MS
00983228
1619902814
HARRISON, DONNIS K MD
VANCLEAVE
MS
129
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04689509
1316147416
HARRISON, JAMES M DO
CLINTON
MS
00119246
1003841073
HARRISON, JERRY S MD
MADISON
MS
00060153
1245377720
HARRISON, JOHN B DMD
NEWTON
MS
06231763
1407268386
HARRISON, JON B MD
JACKSON
MS
03057554
1376712364
HARRISON, LOUIE III V
WINONA
MS
09200033
1457763336
HARRISON, NANCY S MD
JACKSON
MS
06505873
1144626706
HARRISON, PREETHI S PA
GULFPORT
MS
00019636
1255365771
HARRISON, ROBERT B
JACKSON
MS
00660149
1255420337
HARRISON, RONNIE DMD
LUCEDALE
MS
00120961
1992894653
HARRISON, SCOTT E MD
FLOWOOD
MS
03751275
1568676344
HARRISON, SEBRON W MD
JACKSON
MS
02326096
1215224845
HARRISON, VIRGINIA A MD
JACKSON
MS
07670515
1003084617
HART, RODERICK MD
KOSCIUSKO
MS
07005250
1700320660
HART, SHAQUALAR NP
COLUMBUS
MS
04025526
1841665494
HARTHCOCK, CONSTANCE M FNP
BRANDON
MS
06184536
1114111978
HARTLINE, MEREDITH P NP
STARKVILLE
MS
00115727
1831152164
HARTNESS, STANLEY D MD
KOSCIUSKO
MS
00123474
1073566063
HARTT, LLOYD L MD
BAY ST LOUIS
MS
04973557
1215267018
HARTZOG, REBECCA B CNP
HATTIESBURG
MS
02353252
1336543305
HARVEY, ALICIA B CFNP
COLUMBIA
MS
00115021
1881660942
HARVEY, JAMES K MD
TUPELO
MS
08625510
1982991436
HARVEY, JESSIE G MD
JACKSON
MS
09636854
1982012548
HARVEY, JOHN N
MCCOMB
MS
00122271
1043223639
HARVEY, MARTIN D MD
COLLINS
MS
09157010
1013357433
HARVEY, MEGAN M MD
JACKSON
MS
04558033
1740664127
HARVEY, ROBERT S NP
JACKSON
MS
01887731
1528493053
HARVILLE, KAYLA B FNP
GRENADA
MS
00113930
1053345157
HARWELL, JAMES L MD
PASCAGOULA
MS
130
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00123437
1710983150
HASHMAT, AAMIR MD
MERIDIAN
MS
02984302
1700089521
HASHMI, RAZA U MD
HATTIESBURG
MS
04879269
1134495237
HASSELL, JESSICA M MD
JACKSON
MS
00116463
1235178997
HASSELL, JOHN F MD
JACKSON
MS
02970372
1518321496
HATCH, SPENCER T DO
JACKSON
MS
09632742
1497761837
HATFIELD III, ARLIN G MD
JACKSON
MS
02200281
1740416429
HATFIELD, JOSHUA M O.D.
FULTON
MS
05183339
1134221419
HATHCOCK, STEPHEN S MD
SMITHVILLE
MS
00660439
1225259104
HATHORN, ALICIA R DMD
JACKSON
MS
05408094
1487755617
HATHORN, LANDALL C MD
FLOWOOD
MS
00060323
1225130040
HATHORN, PAUL I
ELLISVILLE
MS
00060050
1912018748
HATHORN, RANDY S DMD
BASSFIELD
MS
08783528
1689958902
HATTAWAY, MANDY N NP
BYRAM
MS
00110612
1912948894
HATTEN, KARL W MD
JACKSON
MS
00012631
1487666061
HATTEN, LEWIS E MD
HATTIESBURG
MS
02056754
1275943086
HAUGH, DESIREE B NP
CLARKSDALE
MS
07707094
1588958169
HAUPTMAN, ROBERT J DMD
MADISON
MS
07303594
1881673648
HAUSMANN, JAN M MD
BRANDON
MS
00880022
1346215274
HAUTOT, MARC A OD
PICAYUNE
MS
00115542
1316928955
HAVENS, MICHAEL R MD
BATESVILLE
MS
00112934
1548305279
HAWKINS, ARVIS L MD
GREENVILLE
MS
01220223
1952561599
HAWKINS, LAUREN B MD
HATTIESBURG
MS
00123469
1336273572
HAWKINS, ODESSA S CFNP
JACKSON
MS
01179021
1932593902
HAWKINSON, EMILY C MD
JACKSON
MS
02250020
1275946162
HAWLEY, JAMES L NP-C
CENTREVILLE
MS
04672046
1174872824
HAWLEY, MICHAEL W DO
CORINTH
MS
09128293
1578748117
HAWNEY, HENRY A MD
GULFPORT
MS
02077856
1881952489
HAY, WILLIAM S MD
BROOKHAVEN
MS
131
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00123081
1922072891
HAYEK, MAROUN E MD
GREENVILLE
MS
00781028
1255321766
HAYES, JACKIE A MD
GULFPORT
MS
03175556
1154364636
HAYES, KEVIN MD
ABERDEEN
MS
08959043
1336579499
HAYES, LISA L CFNP
COLUMBUS
MS
00660393
1376605857
HAYES, ROBERT B DMD
PEARL
MS
07127782
1992092134
HAYES, TIA A FNPC
JACKSON
MS
05637763
1609858109
HAYHURST, BETTY APRN
OLIVE BRANCH
MS
05674258
1821220674
HAYLES, MEREDITH D FNP
MEADVILLE
MS
00125384
1568439602
HAYNES, CATHERINE B NP
GULFPORT
MS
05886275
1366986549
HAYNES, CYNTHIA FNP
RIPELY
MS
06003098
1699716837
HAYNES, DEMONDES MD
JACKSON
MS
02020342
1114301645
HAYNES, JESSICA A OD
OLIVE BRANCH
MS
08673211
1639551583
HAYNES, MCCARLEY E FNP
CLARKSDALE
MS
00114975
1922017342
HAYNES-LAING, ARLEEN G MD
TUPELO
MS
00119447
1811957905
HAYNIE, LISA
JACKSON
MS
00118412
1912943945
HAYS JR, J. CLAY MD
JACKSON
MS
00112735
1922115401
HAYS, ANGELA FNP
ACKERMAN
MS
00012593
1295749919
HAYS, JAMES C MD
JACKSON
MS
06257251
1144631649
HAYSLETT, ANDREW R MD
JACKSON
MS
09300570
1619356722
HAYWARD, LAUREN P MD
JACKSON
MS
09232763
1932185600
HAZLEHURST, WARING M MD
OLIVE BRANCH
MS
04409228
1124201074
HEAD, CHRISTY D DDS
HATTIESBURG
MS
00013805
1528032406
HEADLEY, DAVID M MD
PORT GIBSON
MS
00113810
1649249426
HEADLEY, MASSIE H MD
JACKSON
MS
01202047
1508029380
HEARD, RICHARD K MD
TUPELO
MS
02475361
1811396971
HEARST, RACHEL P NP-C
JACKSON
MS
00120187
1154310571
HEATH, GINA E MD
JACKSON
MS
00118318
1467493247
HEATH, III, CAS E MD
JACKSON
MS
132
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00113720
1114930468
HEATH, ROBERT F MD
PETAL
MS
05525071
1427425958
HEATON, ANNA NP
TUPELO
MS
04203772
1427062884
HEBE DIAZ MD PLLC
BILOXI
MS
04203772
1427062884
HEBE DIAZ MD PLLC
OCEAN SPRINGS
MS
01408074
1255387916
HEBERT, DEBRA DO
MERIDIAN
MS
09005039
1356704308
HEBERT, JUSTIN T MD
JACKSON
MS
00005501
1881643369
HEBERT, MICHAEL C MD
SUMMIT
MS
02850263
1649674342
HECKART, NATALIE W CNP
FULTON
MS
09331541
1245441948
HEDERMAN, APRIL MD
JACKSON
MS
08554090
1144587270
HEINDL, BRITTAIN F MD
HATTIESBURG
MS
03658704
1184701344
HEINTZELMAN, KEVIN A DO
JACKSON
MS
00156575
1316259153
HEITZMANN, CASEY B DMD
RIDGELAND
MS
04183575
1669635512
HEITZMANN, EMILY A DMD
RIDGELAND
MS
08371823
1710183041
HELLER, ADAM MD
TUPELO
MS
03007071
1487616009
HELLING, THOMAS S MD
JACKSON
MS
06385771
1366473464
HELLRUNG, MARC C MD
JACKSON
MS
00880149
1083659684
HELLUMS, MICHAEL S OD
BATESVILLE
MS
06088760
1851308480
HELMHOUT, SHAUN L
OXFORD
MS
05780357
1679782478
HELMLY, PAULA L NP
MOSS POINT
MS
00122486
1588624621
HELMS, PAMELA F
JACKSON
MS
04401051
1902892979
HELMS, STEPHEN E MD
JACKSON
MS
09988555
1528492170
HELTON, ASHLEY L OD
NEW ALBANY
MS
00116737
1881607158
HELVESTON, WENDELL
HATTIESBURG
MS
00119740
1124133400
HEM, HALVOR W M.D.
LONG BEACH
MS
08275268
1770666950
HEMAL, UPMA MD
JACKSON
MS
00116980
1780604066
HEMPHILL, PATRICIA E CFNP
GREENVILLE
MS
06627515
1144476250
HENCE, MARQUINET C DO
MOUND BAYOU
MS
09628556
1518952613
HENCEROTH, WILLIAM MD
CLARKSDALE
MS
133
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00117106
1609904515
HENDERSON III, EVERETT R MD
HATTIESBURG
MS
00660206
1538389655
HENDERSON III, JAMES S D.M.D
HATTIESBURG
MS
00116151
1841289279
HENDERSON, ADELAIDE F MD
COLUMBUS
MS
01224251
1215395306
HENDERSON, ALLISON C PA-C
HATTIESBURG
MS
00117288
1750494472
HENDERSON, ANITA
HATTIESBURG
MS
05453265
1316253115
HENDERSON, CARON G ANP
SHUBUTA
MS
00120473
1972523066
HENDERSON, CHARLES A MD
HATTIESBURG
MS
00113707
1154431963
HENDERSON, CHARLES H MD
HATTIESBURG
MS
08529565
1770974446
HENDERSON, DENISE L CNP
JACKSON
MS
00121878
1346222890
HENDERSON, EDWARD D MD
COLLINSVILLE
MS
00010301
1811924939
HENDERSON, HAROLD MD
JACKSON
MS
00124926
1588676597
HENDERSON, JAMES L MD
CARTHAGE
MS
02450266
1972647519
HENDERSON, KENYA OD
HERNANDO
MS
09435313
1215976022
HENDERSON, LARRY A MD
LUCEDALE
MS
03452025
1710163050
HENDERSON, TODD M MD
SOUTHAVEN
MS
00120771
1255326765
HENDERSON, WILLIAM E MD
OXFORD
MS
05302713
1376579599
HENDRICK, HAZEL M NP
GOLDEN
MS
00115114
1770559841
HENDRICK, RICHARD G MD
TUPELO
MS
08058551
1598077703
HENDRICKS, WESLEY A DO
WAYNESBORO
MS
00120774
1780791673
HENDRIX, MARY A CFNP
VARDAMAN
MS
02433543
1114188471
HENEGAN JR, JOHN C MD
JACKSON
MS
05175535
1881636132
HENIKEL, OLUWASEUN E MD
SOUTHAVEN
MS
08133506
1831562818
HENKES, KENNETH H PA
TUPELO
MS
00063195
1689727554
HENRY JR., GOLY R DDS
MARKS
MS
04487021
1831430560
HENRY, BRANDI R FNP-B
CORINTH
MS
00011581
1922151711
HENRY, DAVID C
JACKSON
MS
01378761
1235541673
HENRY, JASON S MD
JACKSON
MS
00013255
1982683330
HENRY, MICHAEL A MD
STARKVILLE
MS
134
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00120858
1912989336
HENRY, SAUNDRA K
NEWTON
MS
00010043
1255334280
HENSARLING, JAMES K MD
FLOWOOD
MS
00117060
1801884234
HENSLEY JR, SAMUEL D MD
FLOWOOD
MS
01050724
1144669649
HENSON, ASHLEY S NP
TUPELO
MS
00660315
1003960220
HENSON, JOHN L DMD
JACKSON
MS
07156861
1558361345
HENSON, TERRI H
SOUTHAVEN
MS
01880216
1437198454
HENSON, WILLIAM C MD
MAGEE
MS
02930560
1275744864
HENSON, ZEB K
JACKSON
MS
04387573
1942255260
HERANNEY, SUSAN M NP
COLUMBUS
MS
00126873
1841233475
HERCULES, PETER L MD
BROOKHAVEN
MS
08030584
1891743183
HERING, DANIEL J PA
MCCOMB
MS
00121782
1942213103
HERNANDEZ, CHARLES D DO
HATTIESBURG
MS
00080075
1952357154
HERNANDEZ, CINDY P AMHNP
MERIDIAN
MS
00113115
1508863002
HERNANDEZ, EDUARDO J MD
GULFPORT
MS
00118871
1962522797
HERNANDEZ, GUILLERMO MD
MERIDIAN
MS
00120587
1285603233
HERNANDEZ, JACINTO A MD
SOUTHAVEN
MS
00112980
1891855623
HERNDON, GWENDOLYN
WEST POINT
MS
00121287
1124034590
HERNDON, ROBERT M
JACKSON
MS
01276718
1164629515
HERPICH, BYRON K MD
JACKSON
MS
02450824
1558396424
HERRIN, VINCENT E MD
JACKSON
MS
01032001
1487966750
HERRING JR, ROBERT D MD
LIBERTY
MS
05978231
1639144405
HERRING, BARRY W MD
STARKVILLE
MS
00124326
1831286699
HERRING, JOEL H MD
JACKSON
MS
09906348
1164884557
HERRING, KATYE L MD
JACKSON
MS
00116602
1225053614
HERRING, LEE E MD
FLOWOOD
MS
00670222
1417269275
HERRING, WHITNEY P MD
JACKSON
MS
00015363
1366455545
HERRINGTON III, ROBERT R
COLUMBIA
MS
06807766
1437363967
HERRINGTON, BETTY L MD
JACKSON
MS
135
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06384319
1245648104
HERRINGTON, CASEY A WHNP
LAUREL
MS
00120863
1730192907
HERRINGTON, JAMES M MD
HATTIESBURG
MS
00880007
1831240183
HERRINGTON, LISA E OD
HATTIESBURG
MS
00110680
1831194679
HERRINGTON, R. GLENN
JACKSON
MS
00118939
1518290386
HERRON, LAWANDA FNP
CHARLESTON
MS
00111477
1205992153
HERRON, WOODIE D MD
ABERDEEN
MS
03439561
1083641823
HERSEY, KELLY R MD
JACKSON
MS
03605353
1467565093
HERTZ, DEIDRA A CFNP
OCEAN SPRINGS
MS
07784361
1689046104
HERVEY, KRISNA A PMHNP
CLEVELAND
MS
04303834
1801207873
HERZIK, MICHAEL A MD
JACKSON
MS
00123017
1093734949
HERZOG SR, JOHN L MD
GREENEVILLE
MS
09609876
1144620287
HESLEP, MEAGAN T NP
JACKSON
MS
03089568
1497925465
HESS, STACI R WHNP
WIGGINS
MS
00010628
1861422305
HESTER, DEBORAH MD
AMORY
MS
01785821
1154671303
HESTER, KRISTI H FNP-C
NATCHEZ
MS
05109339
1851331805
HESTER-CONWAY, MOLLY E CFNP
TUPELO
MS
06936339
1861815029
HEWITT, SARAH P FNP
CHOCTAW
MS
00333371
1689915175
HEWLETT, TERESA V NP
OXFORD
MS
00012178
1659388585
HEY III, JOHN P MD
GREENWOOD
MS
00017066
1366477556
HEYER, RICHARD L MD
TUPELO
MS
00018899
1003902388
HIATT JR, WARREN A MD
GULFPORT
MS
08157370
1205256153
HIBBETS, DAVID E DO
HATTIESBURG
MS
06607278
1861808974
HICKMAN, ASHLEY H CPNP
BROOKHAVEN
MS
00384231
1033522073
HICKMAN, AUBRI B FNP
JACKSON
MS
00120596
1477888790
HICKMAN, TRACEY Q FNP P
CORINTH
MS
00130792
1538431002
HICKS, BRITTANY A NP
BILOXI
MS
00629768
1023034097
HICKS, JASON B MD
RIDGELAND
MS
00114331
1649231408
HICKS, JENNIFER O MD
CANTON
MS
136
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00114852
1982600060
HICKS, RANDALL D MD
MERIDIAN
MS
03403770
1306211164
HICKS-ROBERTSON, JESSICA N FNP-C
MOOREVILLE
MS
07403599
1063777472
HIDALGO, JOAQUIN A MD
JACKSON
MS
00121256
1609851492
HIEBERT, TIMOTHY C MD
OCEAN SPRINGS
MS
08031805
1851679542
HIERLMEIER, BRYAN J MD
JACKSON
MS
06172593
1093798894
HIGGINBOTHAM, REBECCA D FNP
MERIDIAN
MS
00116038
1609093665
HIGGINBOTTOM, AMELIA NP
TREMONT
MS
00120116
1285741215
HIGGINS, BARBARA R FNPBC
DIAMONDHEAD
MS
09328351
1285988154
HIGGINS, BRENDA K NP
COLUMBUS
MS
03524357
1467422436
HIGH, LOYD B MD
HATTIESBURG
MS
00123299
1851364228
HIGHFILL, TINA D FNP
SENATOBIA
MS
07889551
1528228541
HIGHTOWER, OLIVIA B MD
GULFPORT
MS
01030240
1700897444
HIGHTOWER, PHYLLIS A MD
MERIDIAN
MS
05376297
1407050230
HIGLEY, THOMAS M MD
OLIVE BRANCH
MS
00322571
1548643802
HILDEBRAND, VALERIE G NP
JACKSON
MS
08426051
1679029276
HILL, ALEXANDER T NP
NEW ALBANY
MS
01386218
1104268713
HILL, ALICEA S OD
HATTIESBURG
MS
04422546
1922559772
HILL, BRUCE E FNP-C
MCCOMB
MS
01253270
1518080803
HILL, CASSIE B MD
TUPELO
MS
01987380
1346349131
HILL, CHARLES D MD
WEST POINT
MS
00116546
1871600189
HILL, CHARLES K MD
OXFORD
MS
00120899
1457437477
HILL, DEBRA W CNFP
PLANTERSVILLE
MS
00119486
1063504157
HILL, DOUGLAS L
TUPELO
MS
07679856
1497011696
HILL, DUSTIN N MD
CORINTH
MS
00114397
1063467140
HILL, EDWARD MD
TUPELO
MS
04078373
1629240999
HILL, HEATHER S MD
AMORY
MS
00660046
1679657951
HILL, JULIA R DMD
INDIANOLA
MS
00011647
1598762247
HILL, JULIAN B
TUPELO
MS
137
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08939211
1053702761
HILL, KATHLEEN E CNM
MERIDIAN
MS
00121654
1508950502
HILL, KATHY D CFNP
FOREST
MS
08681862
1063852473
HILL, KELLEY C MD
MERIDIAN
MS
04900757
1295169019
HILL, LAURA L NP
PONTOTOC
MS
07438261
1033655659
HILL, REBECCA F PNP
JACKSON
MS
00660080
1356443410
HILL, RICHARD D
CARROLLTON
MS
02302061
1083054225
HILL, ROLANDAS L DDS
JACKSON
MS
02959712
1073709077
HILL, RYAN MD
COLUMBUS
MS
04724722
1033302765
HILL, TATE OD
BOONEVILLE
MS
03357351
1811923766
HILL, TERESA NP
JACKSON
MS
00111585
1881638294
HILL, VELMA
JACKSON
MS
00064716
1366537623
HILL, WILLIE J DDS
JACKSON
MS
00121554
1770609364
HILL-CHANCE, GERRI L MD
HAZLEHURST
MS
05532271
1548566441
HILLIARD, AYANA NP
JACKSON
MS
00115980
1710084504
HILLIARD, MARY L FNP
JACKSON
MS
07586267
1053720342
HILLIE, KRISTAL N
OLIVE BRANCH
MS
05728510
1033432919
HILLMAN, CAROLYN R NP
JACKSON
MS
00013820
1043433931
HILLMAN, JOSEPH C MD
STARKVILLE
MS
09655258
1134495443
HILSABECK, ASHLEY N CRNP
PASCAGOULA
MS
00660262
1215076989
HILTON, CLAYTON R DDS
GULFPORT
MS
00115792
1508885435
HINDMAN, STEPHEN H MD
JACKSON
MS
08133268
1952742736
HINES, ERIN K CFNP
FLOWOOD
MS
00012503
1215063219
HINES, KENNETH L MD
GREENWOOD
MS
03003259
1205296704
HINKLE, RENAY D NP
PASCAGOULA
MS
02674552
1952780066
HINSON, CHRISTOPHER M DO
JACKSON
MS
04284521
1467465682
HINTON, ALICIA F NP
TUPELO
MS
00010323
1245341916
HINTON, ARBIE B MD
VAIDEN
MS
08028273
1417248501
HINTON, BENJAMIN K MD
TUPELO
MS
138
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04209852
1841580065
HINTON, LINDSEY S MD
TUPELO
MS
01236074
1629418074
HINTON, SHANTELE M MD
JACKSON
MS
02185531
1528215019
HIRACHAN, PADAM MD, F
NATCHEZ
MS
00660374
1790875912
HIRSBERG, BRYANT DMD
CLARKSDALE
MS
00018555
1598795171
HIRSCH, CATHERINE P MD
PASCAGOULA
MS
00119144
1114995537
HIRSCHFIELD, WULF MD
WAYNESBORO
MS
00459700
1467641787
HIRSH, DAVID I MD
HATTIESBURG
MS
04951768
1790706000
HIRSHMAN, BRUCE DO
FLOWOOD
MS
00113183
1962436196
HITT, KEVIN L
TUPELO
MS
00035564
1053760850
HITT, LAUREN E NP
GULFPORT
MS
06522851
1356566459
HO, MAI H MD
CHOCTAW
MS
00122154
1114008703
HOAT M HOANG MD
AMORY
MS
09287705
1275731747
HOBBS, CHARLOTTE MD
JACKSON
MS
00016465
1801902309
HOBBS, MILTON D MD
OXFORD
MS
04372863
1518329937
HOBBS, MITCHELL W MD
JACKSON
MS
04425091
1093137309
HOBGOOD, CAROL E CNP
TYLERTOWN
MS
02889260
1578502407
HOBGOOD, EDWARD R MD
JACKSON
MS
06222257
1164862264
HODA, NICHOLAS E MD
JACKSON
MS
00119083
1487639019
HODGE, KRISTA K FNP
CARRIERE
MS
03435398
1366774622
HODGE, LISA F
TUPELO
MS
00660155
1386708022
HODGE, THOMAS W DMD
BATESVILLE
MS
01255511
1992841365
HODGES, ADAM W
GREENWOOD
MS
06621755
1932272200
HODGES, DONNA A CFNP
JACKSON
MS
00012828
1942213152
HODGES, JAMES M
HATTIESBURG
MS
09551264
1336504513
HODGES, LAMONICA A NP
SHAW
MS
07831008
1639331994
HODGES, LUCY B FNP
GREENWOOD
MS
04408537
1982935623
HODGES, PAMELA G
TUPELO
MS
00123674
1013055599
HODGES, REBECCA MD
WINONA
MS
139
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06926840
1760600340
HOF, DOUGLAS A MD
OLIVE BRANCH
MS
05538702
1720461262
HOFSTEDE, DUSTIN MD
JACKSON
MS
00122989
1417950833
HOGAN, CHRISTOPHER D MD
GULFPORT
MS
06900573
1356504682
HOGAN, III, REED B MD
FLOWOOD
MS
06426251
1063831097
HOGAN, KEVIN T MD
VICKSBURG
MS
08885816
1982691531
HOGAN, MICHAEL B MD
GULFPORT
MS
00115723
1023006293
HOGAN, REED B MD
FLOWOOD
MS
05082803
1033271937
HOGGATT, WILTON E DDS
OXFORD
MS
02556221
1619943503
HOGUE, MICHAEL S MD
JACKSON
MS
08357556
1093866303
HOKAN, KAMAL MD
CLARKSDALE
MS
01705300
1790795110
HOLADAY, HOWARD R MD
JACKSON
MS
00115198
1962546192
HOLBROOK, CHIP D MD
MENDENHALL
MS
00125593
1942276845
HOLCOMB, CINDY O CFNP
SALTILLO
MS
08132351
1013236975
HOLCOMBE, ELIZABETH J MD
AMORY
MS
00186895
1033581152
HOLDEN, BELINDA H PMHNP
GULFPORT
MS
04182554
1164702825
HOLDEN, JENNIFER L MD
JACKSON
MS
00115498
1043238637
HOLDEN, THOMAS E MD
GRENADA
MS
04179262
1821016031
HOLDER JR., MICHAEL G MD
JACKSON
MS
00660314
1649309634
HOLDER JR., RAY DMD
JACKSON
MS
00114684
1700977675
HOLDER, ALISON L FNP
BAY SPRINGS
MS
00126546
1881688703
HOLDER, CARLA D
HATTIESBURG
MS
01803761
1306877139
HOLDER, NNEKA A MD
JACKSON
MS
01253870
1942595202
HOLDINESS, SAMUEL J MD
KOSCIUSKO
MS
08128514
1922312388
HOLIFIELD JR, DAVID M OD
QUITMAN
MS
00115067
1285657916
HOLLAND, CHARLES M
BROOKHAVEN
MS
00874238
1982652871
HOLLAND, DANIEL MD
HATTIESBURG
MS
00118024
1063527356
HOLLAND, JAMES S MD
GULFPORT
MS
00110596
1851404495
HOLLAND, JOHN G
HATTIESBURG
MS
140
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00114913
1770698078
HOLLAND, MAUREEN S MD
GULFPORT
MS
05854833
1700020005
HOLLEY, ANDY W DO
CORINTH
MS
06786311
1164727269
HOLLEY, TONIAH NP
PHILADELPHIA
MS
00275723
1982618369
HOLLIBAUGH, BECKY F DO
BAY ST LOUIS
MS
00200336
1053335372
HOLLIDAY, HARRY R MD
STARKVILLE
MS
01300031
1649350836
HOLLIMAN, RENATA G NP
PASCAGOULA
MS
05975012
1881920817
HOLLIMON, BRIAN C FNP
HATTIESBURG
MS
01772200
1073964946
HOLLIMON, BRITTANY L CNP
HATTIESBURG
MS
07354043
1265729719
HOLLINGER, JASMINE C MD
JACKSON
MS
00115162
1972521185
HOLLINGSHEAD, DEBORAH S NP
HATTIESBIRG
MS
00660044
1063678431
HOLLINGSWORTH, JAMES W DMD
NEWTON
MS
01671306
1609187152
HOLLINGSWORTH, REBECCA E GNP
JACKSON
MS
02037341
1023498987
HOLLINGSWORTH, TIFFANY T DMD
CORINTH
MS
06432026
1689818155
HOLLINS, ANTHONY M MD
SOUTHAVEN
MS
00010599
1689617185
HOLLISTER, JOHN J
COLUMBUS
MS
00120887
1366451387
HOLLMAN, AMY B M.D.
BRANDON
MS
02757032
1972051522
HOLLOWAY, DANIEL J PMHNP
JACKSON
MS
00660065
1639236763
HOLLOWAY, III, DENNIS DDS
JACKSON
MS
02888729
1801997127
HOLLOWAY, KAREN MD
WHITFIELD
MS
00983722
1003045410
HOLLOWAY, PATSY L FNP
QUITMAN
MS
00660438
1083627509
HOLLOWELL, ASHLEY D DMD
CANTON
MS
03651066
1235163106
HOLM, NEAL T MD
HATTIESBURG
MS
03930005
1124115134
HOLMAN, JOHN K DDS
TUPELO
MS
00124315
1073576070
HOLMAN, MICHAEL G
KOSCIUSKO
MS
00123662
1962408302
HOLMES, EDWARD H MD
MERIDIAN
MS
06656855
1265830541
HOLMES, KASIE S FNP-C
BROOKHAVEN
MS
00118863
1942297858
HOLMES, KEVIN H MD
COLUMBIA
MS
02605580
1770864613
HOLMES, KIYO P FNP-C
MOUND BAYOU
MS
141
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00935892
1679843544
HOLMES, LAUREN B FNP
MERIDIAN
MS
05558810
1447236732
HOLMES, RICHARD E
MISSISSIPPI STATE
MS
00120538
1407991086
HOLMES, ROCKY D NP
FLOWOOD
MS
00387587
1447470299
HOLT, DEREK L FNP
JACKSON
MS
05527366
1629442249
HOLT, EVELYN M NP
GULFPORT
MS
05436046
1043671696
HOLTON, NIKKI C NP
COLUMBIA
MS
00120311
1144263823
HOLY, JAMES W
MERIDIAN
MS
00015497
1245224872
HOLZHAUER, JAMES L MD
COLUMBUS
MS
00603763
1619975026
HOMAYUNI, ALI R MD
MCCOMB
MS
06821508
1932314291
HONG, JENNIFER L MD
JACKSON
MS
04359397
1275820722
HONG, SHARON N MD
JACKSON
MS
01626339
1033188248
HONG, TAO MD
JACKSON
MS
00126039
1629011150
HONTZAS, JOHN T MD
JACKSON
MS
05138324
1548589120
HOOD, BRENDA J FNP
SENATOBIA
MS
03407867
1447622196
HOOD, KAYLA E NP
TUPELO
MS
05078896
1609962216
HOOD, WILLIAM DDS
MACON
MS
06732570
1326052119
HOOD, WILLIAM A DO
FLOWOOD
MS
04679751
1407861834
HOOKER JR, PHILLIP A OD
SOUTHAVEN
MS
08123251
1609808450
HOOKER, DAVID A MD
MERIDIAN
MS
00406269
1073909271
HOOKER, JEFFREY D MD
JACKSON
MS
01621770
1164504890
HOOKER, MEGAN M
PONTOTOC
MS
07951080
1861406894
HOOKER, PHIL A
WEST POINT
MS
00069255
1831303858
HOOKER, TONY D DDS
SOUTHAVEN
MS
09202751
1174896245
HOOKS, NANCY D DNP
TUPELO
MS
06754371
1447561212
HOOKS, STACY G MD
SOUTHAVEN
MS
01607390
1780614867
HOOPER IV, ARCHIE D MD
MERIDIAN
MS
00125362
1396776514
HOOVER, DEBORAH A NP
VICKSBURG
MS
00064606
1689892036
HOOVER, DENNIS A DDS
WINONA
MS
142
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118337
1962493577
HOOVER, RICK D DO
GAUTIER
MS
00011948
1255365847
HOPKINS, DONALD A MD
GULFPORT
MS
07375353
1528227527
HOPKINS, ERICA H MD
GULFPORT
MS
07950022
1225326093
HOPKINS, LAUREN FNP-C
CORINTH
MS
00886323
1619941127
HOPKINS, MARC D MD
MERIDIAN
MS
06787895
1720191380
HOPKINS, ROCHELLE M OD
HATTIESBURG
MS
09684229
1730104928
HORD, DELPHIA M MD
CLARKSDALE
MS
00660189
1063585693
HORN JR, THOMAS O DMD
PHILADELPHIA
MS
00018038
1811933948
HORN, FLOYD MD
GRENADA
MS
00118187
1659371128
HORN, GREGORY W
OCEAN SPRINGS
MS
05900898
1518991090
HORN, MICHELLE M MD
JACKSON
MS
02285303
1467682385
HORN, NICHOLE PA
BILOXI
MS
00060268
1730281809
HORN, TEENA DMD
HOUSTON
MS
00010732
1902854227
HORN, VICTOR MD
HOUSTON
MS
00010074
1417961012
HORNE, WILLUS M MD
LAUREL
MS
00121377
1841341369
HORSLEY, W. STEWART MD
JACKSON
MS
03602857
1174908420
HORTON DRUMMOND, MELODY C NP
OCEAN SPRINGS
MS
04906870
1679661086
HORTON, PATTY M CFNP
MACON
MS
05808531
1518412691
HORTON, STARLA H NP
TUPELO
MS
08336231
1811208143
HOSCH, RICHARD E DO
JACKSON
MS
08271296
1114136751
HOSEMANN, CHARLES D MD
FLOWOOD
MS
01235702
1396833893
HOSEY, JASON R MD
RIDGELAND
MS
00126269
1316979826
HOSKINS, LULA O FNP
CLARKSDALE
MS
03376839
1316180870
HOSSEINI-CARROLL, PEGAH MD
JACKSON
MS
00015473
1861424780
HOTH, JAMES J MD
WOODVILLE
MS
00553480
1598079659
HOTHI, JATINDER MD
JACKSON
MS
00116659
1972537355
HOUIN JR, JEFFREY C MD
TUPELO
MS
00111435
1588763197
HOUSE III, JAMES R
JACKSON
MS
143
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03782347
1013254358
HOUSE, ASHLEY B NP
GULFPORT
MS
05937858
1366854028
HOUSE, LAURA K MD
JACKSON
MS
00118535
1528034410
HOUSLEY, GEORGE A
TUPELO
MS
00128347
1972048304
HOUSTON, JENNIFER W NP
JACKSON
MS
07520371
1841478120
HOUSTON, LESLIE H CFNP
JACKSON
MS
06279311
1093919714
HOUSTON, LILLIAN J MD
JACKSON
MS
03675860
1568729457
HOUSTON, SAMANTHA MD
OXFORD
MS
06179845
1922402247
HOUZE-REED, LATISHA P FNP-C
BEAUMONT
MS
00064671
1922113265
HOVER, JAMES W DDS
MERIDIAN
MS
08338850
1023145430
HOWARD JR, CHARLES D DMD
JACKSON
MS
00116046
1891896510
HOWARD, ARCHIE A MD
FOREST
MS
00116214
1003844242
HOWARD, CRAIG S
HATTIESBURG
MS
00123324
1821037177
HOWARD, JEFFREY C MD
MONTICELLO
MS
06608759
1609187293
HOWARD, WALTER S NP
MERIDIAN
MS
00122347
1164439758
HOWARD, WILLIAM P M.D.
JACKSON
MS
00876318
1497799118
HOWARD-CLAUDIO, CANDACE M MD
JACKSON
MS
00064763
1265642672
HOWELL JR, GENE N DDS
RIPLEY
MS
00010661
1538258975
HOWELL, GEORGE L MD
STARKVILLE
MS
00124911
1699730150
HOWELL, II, GEORGE E MD
JACKSON
MS
00114268
1447237847
HOWELL, KAREN K CFNP
HATTIESBURG
MS
05271366
1366999799
HOWELL, LORI B CNP
HATTIESBURG
MS
05202503
1386813632
HOWELL, MARY A ANP
MERIDIAN
MS
00019915
1174606941
HOWELL, MICHAEL G DO
TISHOMINGO
MS
04502705
1366470700
HOWELL, PATRICIA D CRNP
COLUMBUS
MS
00119591
1811999667
HOWELL, PHILIP NP
TUPELO
MS
00110676
1225069677
HOWELL, SHELBY C MD
AMORY
MS
00125559
1053387969
HOWELL, WENDY O NP
SALTILLO
MS
03801518
1134238496
HROM, JOHN S MD
HATTIESBURG
MS
144
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09957508
1124225313
HSU, JOHANN H MD
JACKSON
MS
00013423
1386658417
HSU, PATRICK S MD
CORINTH
MS
01430200
1891020871
HTIKE, NAING L MD
SOUTHAVEN
MS
06605028
1164479812
HUANG, BO
JACKSON
MS
00052803
1477851996
HUANG, JUEBIN MD
JACKSON
MS
00114632
1104853936
HUBACEK, LAWRENCE J MD
JACKSON
MS
00017202
1174650956
HUBBARD, JAMES MD
TUPELO
MS
00880063
1073622106
HUBBARD, JR, BENJAMIN T O.D.
BATESVILLE
MS
08706760
1083964092
HUBBARD, MARIEL C MSN
JACKSON
MS
00060139
1386733632
HUBBERT, MICHAEL W
QUITMAN
MS
00120520
1952399016
HUBBLE, ANTOINETTE M MD
MCCOMB
MS
00115244
1487753414
HUBBS, DAVID R MD
MCCOMB
MS
00117010
1487767281
HUBER, MIKE S MD
LUCEDALE
MS
04509838
1922032481
HUCKABAY, CHADWICK A
JACKSON
MS
08773841
1528218112
HUCKABAY, SABRINA C DDS
JACKSON
MS
06771370
1093784209
HUDDLESTON, VIVIAN E MD
GREENWOOD
MS
00605344
1285762666
HUDGENS, JOSEPH L MD
JACKSON
MS
00104505
1447301072
HUDSON, BENJAMIN W M.D.
PASCAGOULA
MS
00122670
1013930122
HUDSON, CLAY B MD
COLUMBUS
MS
05621784
1043249485
HUDSON, CLEVELAND A MD
HATTIESBURG
MS
06287315
1568404002
HUDSON, GRACIA T PAC
PASCAGOULA
MS
00019293
1326152232
HUDSON, JACK
HATTIESBURG
MS
00112585
1023122942
HUDSON, JEFFREY L
HATTIESBURG
MS
09602339
1326437740
HUDSON, JEREMY NP
BRANDON
MS
05486078
1619362977
HUDSON, SHAMECA NP
BRANDON
MS
01432705
1033421375
HUDSON, SHAMIKA B MD
RIDGELAND
MS
06428508
1518286392
HUDSON, SHAY M NP
JACKSON
MS
00116626
1083639744
HUDSON, STARKEY L MD
PHILADELPHIA
MS
145
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04359722
1609311737
HUDSPETH, AINSLIE MIELE S NP
PONTOTOC
MS
00111231
1780643494
HUEY, ROGER L MD
TUPELO
MS
01980582
1992163588
HUEY, RONA K FNP-C
SHAW
MS
05325811
1962532929
HUFFMAN III, JEWEL J MD
EUPORA
MS
05830268
1477955177
HUFFSTATLER, MARLANA CFNP
PONTOTOC
MS
00660083
1588867337
HUGGINS, JOHN M DMD
OXFORD
MS
03255018
1598898967
HUGHES III, R CONDON MD
MERIDIAN
MS
00015263
1679516017
HUGHES JR, JAMES L MD
JACKSON
MS
00118311
1427073170
HUGHES JR, VERNON T DO
ACKERMAN
MS
06271376
1023049210
HUGHES, CHRIS D DMD
CLINTON
MS
00126837
1780622035
HUGHES, KAREN MD
TUPELO
MS
00119643
1659469534
HUGHES, KAREN H MD
FLOWOOD
MS
07725746
1326079047
HUGHES, KATHERINE FNP
LEXINGTON
MS
09020086
1932391786
HUGHES, MICHELE H MD
OCEAN SPRINGS
MS
09372217
1407307408
HUGHES, MINDY B NP
JACKSON
MS
00629068
1710328844
HUGHES, ROSALIND N FNP
SOUTHAVEN
MS
01230522
1063806198
HUGHES, TARA G MD
JACKSON
MS
02234285
1356791982
HUGHES, TRENTON J FNP
MERIDIAN
MS
00015012
1093719601
HUGHES, WAYNE A
HATTIESBURG
MS
00123105
1013026947
HUGHEY, TONYA C NP
BROOKHAVEN
MS
08527858
1114933116
HUGHLEY, ANN D MD
GULFPORT
MS
07877328
1245607373
HUGULEY, HEATHER PA
CORINTH
MS
09807209
1578903563
HULET, RENE E DO
JACKSON
MS
09025855
1427469592
HULICK II, ROBERT M MD
JACKSON
MS
02689551
1437577707
HULICK, RACHEL E MD
JACKSON
MS
05671828
1316936917
HULING JR, RANDALL T MD
OLIVE BRANCH
MS
00120566
1215020193
HULL, CHRISTIE C FNP
MADISON
MS
00773319
1437232717
HULL, CLINTON E DO
JACKSON
MS
146
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00016061
1063628808
HULL, EDGAR W MD
PASCAGOULA
MS
08686521
1902068745
HULL, RACHEL N M.D.
MERIDIAN
MS
03203529
1710371018
HULTS, ALEXANDRIA J NP-C
BILOXI
MS
00880128
1396808259
HUMBER IV, JAMES F OD
CLARKSDALE
MS
00125863
1861506792
HUMPHERYS, BRIAN E MD
HATTIESBURG
MS
00225544
1639552490
HUMPHREYS, LAURA B FNP
BILOXI
MS
04828560
1326441668
HUMPHREYS, LINDSAY E MSN
JACKSON
MS
04838574
1316981806
HUMPHREYS, MICHAEL C DMD
COLUMBIA
MS
06227555
1952795387
HUMPHRIES, JENNIFER E NNPBC
JACKSON
MS
08170279
1497731236
HUMPHRIES, TONY L DMD
COLUMBIA
MS
06683398
1467716548
HUNT, APRIL E FNP-C
JACKSON
MS
00532738
1659721116
HUNT, ARLENE D CFNP
PORT GIBSON
MS
00880168
1164582334
HUNT, BRIAN L
PASCAGOULA
MS
00900353
1902989007
HUNT, ELBERT A M.D.
BYHALIA
MS
00119152
1346268786
HUNT, HARRY G MD
COLUMBIA
MS
04437752
1437370988
HUNT, KYLE T DMD
JACKSON
MS
00017320
1407844202
HUNT, MARION G MD
OXFORD
MS
00118250
1881603538
HUNT, NOEL K MD
TUPELO
MS
00064410
1215009980
HUNT, RODNEY A DDS
JACKSON
MS
00660029
1710288873
HUNTER MOORE, JACQUELYN M DDS
MERIDIAN
MS
00834218
1467459149
HUNTER, JOSEPH
SOUTHAVEN
MS
06423025
1376555045
HUNTER, LINDA N CFNP
FLORA
MS
07306264
1326419359
HUNTER, MARILYN M FNP
NEW ALBANY
MS
04053310
1699935908
HUNTER, STEPHEN E DO
TUPELO
MS
00117902
1174614895
HUNTWORK, JOHN C MD
PASCAGOULA
MS
00060133
1104933316
HUONI, JAMES M DMD
LELAND
MS
05834851
1558785022
HUQ, PHILIP F MD
TUPELO
MS
01973385
1598755100
HURST, ROBERT D DPM
CORINTH
MS
147
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02156061
1033302385
HURT III, JAMES A MD
JACKSON
MS
07876772
1841578242
HURTADO GOMEZ, GABRIEL A MD
HATTIESBURG
MS
05336841
1386908762
HURTT, ROBBIE L MD
JACKSON
MS
03035702
1588894489
HUSSAIN, ALIA MD
RICHLAND
MS
00117430
1922047729
HUSSAIN, IRSHAD MD
ASHLAND
MS
00116641
1821002833
HUTCHESON, ALFRED E MD
MADISON
MS
08728839
1669832150
HUTCHESON, HOLLY PA
JACKSON
MS
00114426
1033150263
HUTCHINS, BOB W MD
DURANT
MS
08437077
1902268592
HUTCHINS, SARA C MD
JACKSON
MS
06179048
1710006481
HUTSON SIMONE, NICOLE R CPNP
MCCOMB
MS
07805503
1467833608
HUTTO, DAPHNE J CRNP
PASCAGOULA
MS
08722731
1508037243
HUTTO, DARRELL M DMD
JACKSON
MS
06283268
1023320322
HUTTO, ERIC D MD
OXFORD
MS
00934062
1972671626
HUXFORD, CAMERON S MD
STARKVILLE
MS
01359781
1720281694
HUXFORD, MARY P DMD
STARKVILLE
MS
07739398
1063428449
HYATT, DEBORAH A CFNP
LUCEDALE
MS
03781882
1609888197
HYDE, ERIC L DDS
GULFPORT
MS
00124203
1770548950
HYER JR, JERRY D MD
GULFPORT
MS
07082322
1639540958
HYPOLITE, TEKIRA DMD
MERIDIAN
MS
00707297
1659699247
HYSMITH, JESSICA H MD
OLIVE BRANCH
MS
09053511
1194910448
IDOWU, OMOLOLA O MD
JACKSON
MS
07525065
1629490065
IJAZ, MUHAMMAD U MD
HATTIESBURG
MS
06787521
1013114677
IKEDA, WANDA A ACNP
TUPELO
MS
09479328
1528094851
ILERCIL, ORHAN MD
JACKSON
MS
09533798
1114155884
ILES, JOSHUA W MD
JACKSON
MS
03620888
1982762845
ILIEV, DESSISLAVA D MD
JACKSON
MS
02704031
1376876987
ILIEV, PETER B MD
JACKSON
MS
09226252
1508277609
ILLICH, BENJAMIN M MD
JACKSON
MS
148
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08220740
1184910382
ILO, SHERIFF DO
TUPELO
MS
05251568
1013995216
IMOKE, EFEM E MD
MCCOMB
MS
07835294
1902867021
IMPERIAL JR, ANTONIO-JAIME T MD
HATTIESBURG
MS
09158266
1144483694
INAGAKI, KENGO MD
JACKSON
MS
05203211
1952616328
INDUKURI VENKATA MADHAVA, ASHOKA RAVI VAR MD
SOUTHAVEN
MS
04839726
1851655229
INGRAM, BRANDON D MD
JACKSON
MS
02751204
1588618474
INGRAM, CHARLES C MD
OLIVE BRANCH
MS
00014572
1508969213
INGRAM, FRED H MD
JACKSON
MS
08888868
1134319619
INGRAM, JOHN B MD
JACKSON
MS
00188241
1679952535
INGRAM, JORDAN B
HATTIESBURG
MS
05789851
1689055089
INGRAM, KRISTEN R NP
FLOWOOD
MS
00120516
1245276849
INGRAM, MALINDA M FNP
TUPELO
MS
03309595
1831267756
INGRAM, STACEY S CFNP
YAZOO CITY
MS
00121266
1013069020
IODICE, SUZANNE A
PASCAGOULA
MS
08629866
1902165475
IQBAL, FAHEEM MD
TUPELO
MS
00115941
1801877139
IRBY, BRAXTER MD
BROOKHAVEN
MS
00623835
1821018144
IRELAND, THOMAS A MD
TUPELO
MS
04489221
1013093715
IRIZARRY, HILDA T MD
CHOCTAW
MS
00122029
1669588547
IRIZARRY, LUIS A MD
HATTIESBURG
MS
03026578
1134571458
IRONS, NICHOLAS
JACKSON
MS
00064628
1184796021
IRONS, ROY L DDS
GULFPORT
MS
01873550
1639377344
IRVING, JOSEPH L MD
JACKSON
MS
00115024
1821108077
IRWIN JR, DAVID H MD
TUPELO
MS
00120264
1811934011
ISAACS, JOHN D MD
JACKSON
MS
01230959
1518196070
ISBELL, ADAM D MD
JACKSON
MS
00115876
1982686507
ISBELL, JIMMY E MD
MERIDIAN
MS
07236819
1508057811
ISHEE, DIXIE W FNP
JACKSON
MS
02537341
1568441855
ISLAM, KHONDKER K MD
MERIDIAN
MS
149
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05109210
1568662393
ISLAM, NAHID M.D.
MORTON
MS
09709245
1740453240
ISMILE FAMILY DENTISTRY INC
TUPELO
MS
09709245
1740453240
ISMILE FAMILY DENTISTRY INC
SOUTHAVEN
MS
04120729
1578766374
IVANCIC, ALEXA N MD
TUPELO
MS
00111471
1023034477
IVANCIC, MILAN E
TUPELO
MS
05238248
1285853408
IVERSTINE, CASEY L DDS
NATCHEZ
MS
09027747
1750465118
IVERSTINE, JAMES V DDS
NATCHEZ
MS
09351503
1508885369
IVEY, JACOB A OD
LOUISVILLE
MS
00114933
1790703171
IVEY, RICHARD K MD
LAUREL
MS
06752573
1043662851
IVEY, SARAH N FNP-C
MERIDIAN
MS
00115653
1902802333
IVEY, TIMOTHY R MD
VANCLEAVE
MS
08551324
1851585004
IVORY, DEDRI M MD
VICKSBURG
MS
09436751
1649407917
IWUEKE, CHIKA U MD
TUPELO
MS
02186746
1548524861
IWUJI, KELECHI MD
COLUMBUS
MS
00014337
1598709354
IYER, RATHI V MD
JACKSON
MS
06776244
1124374442
JABARI, DUAA MD
JACKSON
MS
06536832
1003041567
JACKS, STEPHANIE K MD
JACKSON
MS
03059015
1023323078
JACKSON YATES, ELIZABETH L NP
CANTON
MS
00907711
1932202876
JACKSON, ALCHAR NP
OCEAN SPRINGS
MS
05728527
1841505567
JACKSON, ANGELA A MSN
JACKSON
MS
07388805
1154477453
JACKSON, ANTHONY W MD
SOUTHAVEN
MS
00014062
1417061359
JACKSON, ARNOLD J MD
HATTIESBURG
MS
00121439
1376584920
JACKSON, CHRISTOPHER L MD
VICKSBURG
MS
00019909
1821013095
JACKSON, DANNY W
ROLLING FORK
MS
00124165
1477663318
JACKSON, DENA W
BROOKHAVEN
MS
00064699
1760500649
JACKSON, DONALD W DMD
VICKSBURG
MS
09180751
1699937557
JACKSON, ELICEIA D MD
GAUTIER
MS
09130744
1316143282
JACKSON, ELIZABETH R
SOUTHAVEN
MS
150
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09573377
1245213354
JACKSON, GLORIA J
MERIDIAN
MS
01175032
1659757870
JACKSON, JAMES M NP
OCEAN SPRINGS
MS
00602867
1518273499
JACKSON, JENNIFER L FNP
GULFPORT
MS
02585707
1790996544
JACKSON, JEREMY D MD
STARKVILLE
MS
00013024
1073633624
JACKSON, JOE A MD
BILOXI
MS
02632326
1760669345
JACKSON, JON C MD
JACKSON
MS
01371061
1922074806
JACKSON, JOSEPH F MD
OKOLONA
MS
05556532
1811931454
JACKSON, JOY MD
HAZLEHURST
MS
07407357
1417350182
JACKSON, KOSCHER D NP
JACKSON
MS
08350002
1639391311
JACKSON, LANA L MD
JACKSON
MS
01003871
1851795876
JACKSON, LINDSEY NP-C
NATCHEZ
MS
06330523
1497164446
JACKSON, MARY MSN
JACKSON
MS
00011234
1053322974
JACKSON, PAUL D MD
GREENVILLE
MS
00121708
1962583971
JACKSON, PRISCILLA B FNP
NATCHEZ
MS
05435530
1144614165
JACKSON, RANDALL E CFNP
MCCOMB
MS
06289024
1215994231
JACKSON, RICHARD A M.D.
GREENVILLE
MS
00013218
1134153687
JACKSON, RICHARD T
JACKSON
MS
01929209
1669922670
JACKSON, ROBIN L NP
TUPELO
MS
00780035
1821097858
JACKSON, STEPHANIE P CFNP
CANTON
MS
00112669
1558345371
JACKSON, TAMMY Z CFNP
BLUE MOUNTAIN
MS
09902332
1720490691
JACKSON, TERICA H MD
JACKSON
MS
07833786
1124410022
JACKSON, TIFFANY R FNP
HAZLEHURST
MS
03558525
1194858688
JACKSON, WILLIAM D MD
JACKSON
MS
00016794
1407852072
JACKSON, WILLIAM G MD
CORINTH
MS
00115979
1790729119
JACKSON-ASSAD, LYNDA
JACKSON
MS
00121538
1396770749
JACKSON-WILLIAMS, LORETTA MD
JACKSON
MS
04202575
1396156782
JACOBI, SEBASTIAN J DO
JACKSON
MS
02431027
1407238090
JACOBS, AMANDA L DMD
VICKSBURG
MS
151
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03684273
1932131117
JACQUE, JAMES J MD
CORINTH
MS
09120238
1346460078
JACQUELINE, CARRILLO CFNP
JACKSON
MS
03281556
1841361938
JAEGER, DOMINIC A MD
JACKSON
MS
09735376
1346598026
JAFFER, ZEHRA
SOUTHAVEN
MS
00118344
1326149253
JAGADESSAN, JAISHANKAR MD
PRENTISS
MS
09029711
1295017317
JAGGERS, CHRISTY F NP
AMORY
MS
00114829
1477564110
JAH, MOHAMED
CHOCTAW
MS
06326035
1447282991
JAIN, MUKESH MD
SOUTHAVEN
MS
00973541
1881876647
JAIN, NITESH K MD
MCCOMB
MS
01836067
1689822397
JAIN, PANKAJ MD
JACKSON
MS
01282761
1457543183
JAKINS, DIANE C ACNP
GULFPORT
MS
00120852
1841267051
JAMAL, ALTAF A MD
PASCAGOULA
MS
00660153
1023115987
JAMES W ALLEN DMD PC
BILOXI
MS
06304720
1699967679
JAMES, ELIZABETH L MD
HAZLEHURST
MS
02984221
1134672462
JAMES, KYMBERLEIGH E FNP
MERIDIAN
MS
00010144
1588661789
JAMES, MAURICE MD
JACKSON
MS
04139306
1356664825
JAMES, MELISSA A NP
LAUREL
MS
00123680
1043309222
JAMES, REBECCA C MD
JACKSON
MS
08956385
1699886176
JAMES, STEPHEN C MD
GULFPORT
MS
00117160
1982669636
JAMESON, DAVID L MD
TYLERTOWN
MS
00118650
1396700811
JAMESON, REBECCA P MD
SUMRALL
MS
09877843
1922431048
JAMISON, LEE NNP B
FLOWOOD
MS
06731701
1548491673
JAMPANA, SRINIVASA V MD
SOUTHAVEN
MS
00126888
1073603171
JANG, JONATHAN R
COLUMBIA
MS
06384391
1003819269
JANKOV, ALEKSANDAR MD
OXFORD
MS
05836742
1588812341
JANORKAR, DEEPTI BDS
JACKSON
MS
01773773
1275624868
JANOUS, CARRIE S NP
SHELBY
MS
05850217
1255612081
JANZEN, AMBER L FNP
CORINTH
MS
152
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06432790
1518219914
JAQUES, GLORIA S NP
JACKSON
MS
05575269
1336448588
JAQUITH, BRADLEY P MD
SOUTHAVEN
MS
09476300
1225578396
JARANCIK, MEGAN FNP
MCCOMB
MS
00114125
1326074477
JARMON, HENRY M MD
VICKSBURG
MS
01902207
1649365370
JARRETT JR, ROBERT W MD
TUPELO
MS
04677774
1316145352
JAYARAJ, ARJUN MD
JACKSON
MS
07503564
1952795825
JAYARAM, SHOBA MD
JACKSON
MS
03428890
1831109024
JEAN PIERRE, CYNTHIA V MD
PICAYUNE
MS
00015507
1245321801
JEE, JAMES D MD
INDIANOLA
MS
05273751
1043462476
JEFF, SHEILA K MD
JACKSON
MS
05736808
1679792295
JEFFCOAT, BENJAMIN T MD
FLOWOOD
MS
03388061
1679932388
JEFFCOAT, LESLIE M NP
LAUREL
MS
00015689
1750339172
JEFFCOAT, THOMAS T MD
MCCOMB
MS
00019448
1831147917
JEFFERSON, JAMES A MD
BRANDON
MS
00120588
1902998040
JEFFREYS III, KIRK R MD
JACKSON
MS
06673820
1437594918
JEFFRIES, PAMELA I NP
FOREST
MS
04555267
1770921264
JELF, LAURA E MD
JACKSON
MS
06858051
1508978008
JENKINS HINTON, SABRINA L DMD
LEAKESVILLE
MS
09829895
1760692743
JENKINS, AYANNA K MD
JACKSON
MS
02472042
1184622201
JENKINS, CHESTER W MD
GREENVILLE
MS
02480550
1992196331
JENKINS, EUGENE N FNP
MORTON
MS
02657821
1114399284
JENKINS, KRISTIE NP
OXFORD
MS
06531367
1275903197
JENKINS, SHERRIE P CFNP
OXFORD
MS
00660426
1730220690
JENKINS, WILLIAM B DMD
INDIANOLA
MS
00982855
1235210170
JENKINS-LONIDIER, LORA NP
JACKSON
MS
03970365
1598926081
JENNINGS, JASON M DMD
CLEVELAND
MS
06108051
1457389140
JENNINGS, JOHN C MD
HATTIESBURG
MS
00785240
1659768679
JENNINGS, MILLER C DO
JACKSON
MS
153
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04600075
1992935266
JENNINGS, WILLIAM T MD
TUPELO
MS
05887538
1902835473
JENSEN, CYNTHIA A ACNP
OCEAN SPRINGS
MS
02003575
1831194471
JENSEN, PETER MD
JACKSON
MS
08502591
1326073537
JEPSEN, KERRY MD
TUPELO
MS
07605027
1881910677
JERADEH-BOURSOULIAN, FERAS MD
TUPELO
MS
07025002
1639246739
JEREMEY W OWENS MD PC
GULFPORT
MS
05684273
1578805388
JERKINS, EVIN G DO
JACKSON
MS
05050735
1235540691
JEROME, KATHRYN L MD
JACKSON
MS
05553062
1194119040
JESTER, ANGELA M DO
JACKSON
MS
05828251
1659682904
JESUBATHAM, JULIAN J MD
MOUND BAYOU
MS
00704858
1437562196
JETER, JOSHUA B MD
JACKSON
MS
01489305
1407854938
JETT, KATHERINE M NP
JACKSON
MS
08226509
1801904891
JEWELL SR, BAYLOR L MD
SENATOBIA
MS
03506041
1952698532
JEX, KELLEN T MD
JACKSON
MS
00539728
1891907515
JIA, YI MD
NEW ALBANY
MS
00115830
1932102951
JIMENEZ, JAIME MD
HATTIESBURG
MS
06927778
1518353168
JIMENEZ, JORGE A MD
JACKSON
MS
00122993
1609198753
JOBE, SHERRY APN
CORINTH
MS
00671234
1124134374
JOBE, TINA M MD
CORINTH
MS
00122295
1093722688
JOE, DAVID S M.D.
JACKSON
MS
01275866
1831140672
JOGAL, SACHIN S MD
SOUTHAVEN
MS
00116678
1861463788
JOHANSEN, ROBERT L MD
GULFPORT
MS
00064975
1205929684
JOHN A SMITH DDS PA
GREENWOOD
MS
00114017
1881709053
JOHNS, STEPHEN P MD
GULFPORT
MS
04703368
1962440297
JOHNSEY JR, JOSEPH W MD
TUPELO
MS
06623897
1285073890
JOHNSON III, EDWARD W MD
ABERDEEN
MS
00121596
1821180514
JOHNSON JR, JAMES C MD
TUPELO
MS
00122266
1134142334
JOHNSON JR, MATHEW B MD
CORINTH
MS
154
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00015534
1497757603
JOHNSON JR, SIDNEY A MD
JACKSON
MS
01188335
1346680709
JOHNSON JR, WILLIAM B MD
JACKSON
MS
04473866
1225024862
JOHNSON RAGAN, KIMBERLY N OD
MADISON
MS
05801549
1275907354
JOHNSON, ABBEY M NP
SOUTHAVEN
MS
08055030
1275867640
JOHNSON, ALEXIS PAC
SOUTHAVEN
MS
08206704
1265796981
JOHNSON, ALICON K MSN
JACKSON
MS
07837201
1770864381
JOHNSON, AMY C NP
LEXINGTON
MS
09889509
1487621157
JOHNSON, ANGELA M APN
OLIVE BRANCH
MS
09708306
1194136267
JOHNSON, ASHLEY M MD
JACKSON
MS
00105378
1407193378
JOHNSON, BRANDI S ACNP
JACKSON
MS
00114864
1487642518
JOHNSON, BRIAN P MD
JACKSON
MS
07978532
1811330889
JOHNSON, BRITTANY MD
JACKSON
MS
03600303
1437538410
JOHNSON, CHARLES D CNP
HATTIESBURG
MS
03172746
1962757740
JOHNSON, DANIELLE L PA
SOUTHAVEN
MS
06807377
1881743326
JOHNSON, DANNETTE S DO
JACKSON
MS
08681565
1902095664
JOHNSON, DARYL A MD
HATTIESBURG
MS
00660091
1619985272
JOHNSON, DARYL LANCE DMD
CLEVELAND
MS
00123708
1114087483
JOHNSON, DAVID B MD
YAZOO CITY
MS
00125918
1962619932
JOHNSON, DAVID S
MAGEE
MS
00014772
1144322165
JOHNSON, DWIGHT A MD
BOONEVILLE
MS
05952005
1629253950
JOHNSON, EMILY B DO
FLOWOOD
MS
00508237
1295188290
JOHNSON, GREGORY L OD
ABERDEEN
MS
09055254
1518147925
JOHNSON, HENRY P MD
OXFORD
MS
04056301
1700815321
JOHNSON, HOLLYE R MD
JACKSON
MS
00880212
1154345486
JOHNSON, II, ERIC J
MERIDIAN
MS
00111172
1275647117
JOHNSON, JEFFREY A
HATTIESBURG
MS
00118179
1689698318
JOHNSON, JEFFREY N MD
COLUMBIA
MS
08801368
1669836540
JOHNSON, JEREMY M DO
JACKSON
MS
155
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04431870
1902860372
JOHNSON, JOHN A MD
HATTIESBURG
MS
00124004
1285748137
JOHNSON, JOHN J
HATTIESBURG
MS
01504386
1285683342
JOHNSON, JUANTINA M MD
CHOCTAW
MS
07313421
1346217502
JOHNSON, KATHY R CFNP
EUPORA
MS
04406348
1679882286
JOHNSON, KELLY C ACNP
BILOXI
MS
06202721
1992773535
JOHNSON, KEVIN R DO
TUPELO
MS
00110618
1598754913
JOHNSON, KURT D MD
BRANDON
MS
03128220
1427458819
JOHNSON, LATOYA P PA
JACKSON
MS
04302879
1407209489
JOHNSON, LAURA M NP
WHITFIELD
MS
00087883
1417991985
JOHNSON, LINDA OD
JACKSON
MS
07929562
1366636060
JOHNSON, LULA M NP
JACKSON
MS
03954766
1730475815
JOHNSON, MARC E MD
BROOKHAVEN
MS
07002256
1720241102
JOHNSON, MARLA Y MD
JACKSON
MS
00114833
1700827250
JOHNSON, MARTHA J FNP
LAUREL
MS
00124595
1699851634
JOHNSON, MARY A CFNP
CANTON
MS
00122096
1033223995
JOHNSON, MICHAEL W NP
FOXWORTH
MS
02722269
1922381466
JOHNSON, MICHELLE M CFNP
WIGGINS
MS
04732825
1811928013
JOHNSON, MILES M
SOUTHAVEN
MS
05855337
1578951240
JOHNSON, NICOLE L CFNP
GULFPORT
MS
08800247
1770505141
JOHNSON, OLIVIA D FNP
MERIDIAN
MS
01886827
1619081346
JOHNSON, RICHARD S
JACKSON
MS
07084205
1114021722
JOHNSON, ROBERT G MD
OCEAN SPRINGS
MS
00114403
1083638217
JOHNSON, SAMUEL A MD
COLUMBUS
MS
08938291
1619916103
JOHNSON, SONYA WHNP
LAUREL
MS
00110231
1750395356
JOHNSON, STEPHEN P DO
LAUREL
MS
02602740
1871923771
JOHNSON, TAWANDA L FNP
GREENVILLE
MS
00126681
1306947577
JOHNSON, TEMEKA L MD
JACKSON
MS
03310041
1033223904
JOHNSON, TERRANCE A MD
PICAYUNE
MS
156
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00660251
1316042237
JOHNSON, TIMOTHY T DDS
CANTON
MS
00119950
1649273509
JOHNSON, VERONICA Y MD
CHOCTAW
MS
00119695
1033420914
JOHNSON, WANDA N NP
JACKSON
MS
00116953
1649386392
JOHNSON, WILLIAM C MD
FLOWOOD
MS
01880504
1669586996
JOHNSON, WILLIAM D NP
BRANDON
MS
09037861
1245469576
JOHNSON, WILLIAM R MD
TUPELO
MS
00117218
1053315028
JOHNSON, WILLIAM W MD
NEW ALBANY
MS
00886261
1881034890
JOHNSTON, DANIEL T DMD
MERIDIAN
MS
00121566
1306814801
JOHNSTON, JOHN MD
OXFORD
MS
00014424
1952332181
JOHNSTON, JR., WALTER E MD
VICKSBURG
MS
00119937
1700896263
JOHNSTON, LEWIS D
MADISON
MS
04604768
1790717478
JOHNSTON, RICHARD L MD
COLUMBUS
MS
06828701
1265456206
JOHNSTON, WILLIAM E MD
VICKSBURG
MS
00019242
1952305567
JOHNSTON, WORD MD
MOUNT OLIVE
MS
01821061
1831524909
JOINER, LACEY A
BATESVILLE
MS
00110322
1134342223
JOINER, THOMAS E MD
JACKSON
MS
00032390
1467760181
JOLLY ORTHODONTICS
MADSON
MS
00032390
1467760181
JOLLY ORTHODONTICS
MADISON
MS
09604331
1568796043
JOLLY, ASHLEY N NP
JACKSON
MS
06488764
1518279173
JOLLY, DAVID B MD
SOUTHAVEN
MS
00578202
1194755082
JOLLY, JANET M CFNP
JACKSON
MS
09107725
1902210297
JONES III, JACKIE F DMD
FOREST
MS
00389267
1245341726
JONES III, WILLIAM H MD
JACKSON
MS
02572737
1487065900
JONES JR, JEFFERY B MD
JACKSON
MS
00119869
1730293887
JONES JR, ROBERT H M.D.
COLUMBUS
MS
05931769
1043430010
JONES, ADISA J MD
SOUTHAVEN
MS
02451563
1134153638
JONES, ALAN E MD
JACKSON
MS
09331577
1467809962
JONES, AMANDA NP-C
STARKVILLE
MS
157
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00275301
1649474875
JONES, AMY G DMD
MADISON
MS
01959867
1023122900
JONES, ANGELA C MD
POPLARVILLE
MS
02357749
1619177086
JONES, ANGELA M MD
MADISON
MS
06226201
1700292166
JONES, ANYA G MSN
CARTHAGE
MS
00124424
1205940095
JONES, BOBBY G DO
SEMINARY
MS
05156761
1023005360
JONES, BRADLEY K MD
OLIVE BRANCH
MS
04183703
1790040533
JONES, BRIDGET D MD
JACKSON
MS
01006055
1629380639
JONES, CANDICE J DO
IUKA
MS
00660454
1205955283
JONES, DANA H DMD
KILN
MS
01262603
1295955672
JONES, DAVID F MD
JACKSON
MS
01704876
1376724799
JONES, DIETRICHE S CFNP
GREENWOOD
MS
00120262
1033196035
JONES, FREDERICK D MD
SOUTHAVEN
MS
03274861
1760865216
JONES, GARRETT L FNP
BROOKHAVEN
MS
07903363
1164403382
JONES, GARY P MD
MCCOMB
MS
00114974
1518051671
JONES, GORDON S MD
COLUMBUS
MS
04189871
1184672750
JONES, HARRIET L
BRANDON
MS
07408560
1689726283
JONES, JACKIE F DMD
ACKERMAN
MS
00013183
1770577561
JONES, JAMES S MD
JACKSON
MS
00110995
1720032634
JONES, JAMES W MD
OLIVE BRANCH
MS
01401770
1407115397
JONES, JASON K MD
FLOWOOD
MS
04704348
1760646426
JONES, JESSICA D MD
JACKSON
MS
00064640
1174645188
JONES, JOHN H DDS
HOLLY SPRINGS
MS
07756738
1386686392
JONES, JOHN H MD
INDIANOLA
MS
00430397
1881617983
JONES, JONATHAN S MD
JACKSON
MS
00012574
1245268937
JONES, JR., SAMUEL
JACKSON
MS
09454081
1508216961
JONES, KAREN S CPNP
JACKSON
MS
05529869
1316131568
JONES, KEITH O MD
JACKSON
MS
09525060
1790185999
JONES, KELLIE OD
SOUTHAVEN
MS
158
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05788256
1689800401
JONES, KELLY L MD
JACKSON
MS
08926893
1275769796
JONES, KOBI L FNP
JACKSON
MS
03607208
1144632878
JONES, KRISTINA M MD
JACKSON
MS
00064390
1306853882
JONES, LAMAR C DDS
PETAL
MS
09877251
1235201955
JONES, LAUREN B
MCCOMB
MS
09787347
1639532468
JONES, LEE F MD
JACKSON
MS
00016358
1023129566
JONES, LESLIE L MD
MADISON
MS
05937530
1871879783
JONES, LORIN S PA
TYLERTOWN
MS
08950222
1467717801
JONES, LOUIS B MD
JACKSON
MS
08939785
1518920511
JONES, MARY A NP
FLOWOOD
MS
00126035
1013001189
JONES, MATTHEW B MD
LAUREL
MS
05277550
1043453517
JONES, MELISSA K MD
NATCHEZ
MS
03935260
1528004249
JONES, MONICA M CFNP
RULEVILLE
MS
03539538
1598178253
JONES, OSCAR R DMD
WAYNESBORO
MS
00015920
1659399723
JONES, PHILLIP E
TUPELO
MS
03472708
1972715118
JONES, RITA D NP
ASHLAND
MS
05634331
1881946465
JONES, ROBBIE NP
TUPELO
MS
00010621
1780652057
JONES, RUBEN B
TUPELO
MS
09078752
1720524648
JONES, SAMANTHA L PA-C
HATTIESBURG
MS
07338088
1366571903
JONES, SANDRA N FNP
HERNANDO
MS
09928001
1215165980
JONES, SARAH M MD
RIDGELAND
MS
03377578
1689618670
JONES, SHUNTE'
GREENWOOD
MS
01925759
1568845162
JONES, SOLITA R MD
JACKSON
MS
00126510
1285664722
JONES, STEPHEN C MD
BILOXI
MS
00709348
1497707707
JONES, TERRELL E DMD
STARKVILLE
MS
00660405
1649488321
JONES, THERESA G DMD
GULFPORT
MS
02207749
1134384670
JONES, THOMAS M MD
JACKSON
MS
02934509
1023187689
JONES, TOMMIE K CFNP
CARTHAGE
MS
159
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01584295
1326320896
JONES, TRAKENA C OD
JACKSON
MS
05156831
1174965982
JONES, VICTORIA E DMD
TUPELO
MS
00016786
1013944214
JONES, VIRGINIA A M.D.
JACKSON
MS
00015673
1407948284
JONES, WILLIAM B MD
GREENWOOD
MS
07501051
1265879035
JONES, WILLIAM H DMD
FLOWOOD
MS
08127324
1275753444
JONES-JURINKA, DANA C CFNP
BILOXI
MS
03820257
1144629510
JONES-STEWART, ANGELA M CNP
CANTON
MS
00019157
1669417960
JORANSEN, JAMES A MD
JACKSON
MS
06724502
1407858541
JORANSEN, RANDALL S
MERIDIAN
MS
00125687
1528067915
JORDAN III, THEODORE F MD
MCCOMB
MS
06101829
1659620003
JORDAN, BRENDA MD
VICKSBURG
MS
00809811
1306126263
JORDAN, CHARLES R NP
CLEVELAND
MS
05275550
1679930929
JORDAN, CHRISTINA D NP
TUPELO
MS
00115759
1275572471
JORDAN, COVIN M MD
OXFORD
MS
00125504
1831129295
JORDAN, ERIC W MD
HATTIESBURG
MS
00125977
1811968746
JORDAN, JAMES R MD
JACKSON
MS
04556544
1376997957
JORDAN, JAXON W MD
JACKSON
MS
09720821
1922205889
JORDAN, KEVIN T MD
BILOXI
MS
04939709
1073560652
JORDAN, LESA L MD
BRANDON
MS
03426357
1659400885
JORDAN, NANCY FNP
DEKALB
MS
09383254
1790072288
JORDAN, RASHEDA K CFNP
RIDGELAND
MS
00114816
1417046327
JORDAN, TERRY T
MERIDIAN
MS
00116649
1962451294
JORDON, RENIE A
MCCOMB
MS
08328018
1871737064
JORNS, JACOB J MD
GULFPORT
MS
04204205
1417191222
JORNS, LAINIE MD
GULFPORT
MS
00087245
1760547574
JOSEPH, JOSEPH J OD
PEARL
MS
08929505
1528350006
JOSEPH, ZEENA P MD
SOUTHAVEN
MS
02783252
1962664110
JOSEY JR, DAVID MD
JACKSON
MS
160
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00017219
1205919495
JOSHI, CHANDRASHEKHAR V
CHOCTAW
MS
00087331
1073500716
JOSLIN, TERRY M
NEW ALBANY
MS
00125121
1366490302
JOUDEH, MAAN MD
AMORY
MS
02521227
1871555011
JOYNER, CHRISTINA C FNP
HOLLY SPRINGS
MS
03276757
1548425861
JOYNER, DAVID A MD
JACKSON
MS
08204878
1376905901
JUAKALI, EBONY A
HATTIESBURG
MS
00011116
1689666539
JUCHHEIM III, ALWIN M DPM
GRENADA
MS
01785707
1235338971
JULIUS, QUINTIN T DDS
TCHULA
MS
08382844
1003027376
JUNCK, ANTHONY D MD
GULFPORT
MS
00059370
1124092416
JUNCOS, LUIS A MD
JACKSON
MS
03829540
1386978153
JUNKINS, JAMES P PA
GULFPORT
MS
01837825
1366774879
JURICH HENDERSON, JENNIFER NP
BILOXI
MS
00120672
1043225576
JURNEY, NINA P
ABERDEEN
MS
07126570
1124480033
JUSTICE JR, WILLIAM R MD
JACKSON
MS
03583097
1265675664
JUSTICE, ADAM E DO
PASCAGOULA
MS
03300994
1568610806
JUSTICE, ANDREW C CFNP
ABERDEEN
MS
06356200
1487104675
JUSTICE, ANGEL I NP
TUPELO
MS
05186329
1184614620
JUSTICE, CLARENCE A MD
TUPELO
MS
02685789
1013267152
JUSTICE, SAMANTHA FNP
CORINTH
MS
00060280
1932171576
JUSTUS, ROBERT S DDS
QUITMAN
MS
08755026
1932209715
JUZANG, RHODA NP
BILOXI
MS
01726590
1285845933
KABIR, AZAD A MD
BILOXI
MS
00117526
1063526895
KAHLER, RALPH C MD
HATTIESBURG
MS
00660255
1982744850
KAIRIT, BRANT H DMD
SENATOBIA
MS
02876526
1073557039
KAISER, KENNETH P NP
JACKSON
MS
05805572
1053304881
KALE, DEEPALI R MD
GREENVILLE
MS
07800040
1851659353
KALIKKOT THEKKEVEEDU, RENJITHKUMAR MD
JACKSON
MS
00120585
1205836764
KALISH, JONATHAN R
TUPELO
MS
161
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07809303
1467494849
KAMALAPUR, VIDYA MD
NATCHEZ
MS
00018100
1235105479
KAMATH, KISHORE V MD
PICAYUNE
MS
08873261
1346344421
KAMELMAZ, IZZEDDIN
JACKSON
MS
03800774
1114023447
KAMMONA, HUSSEIN A MD
MERIDIAN
MS
08372841
1598997314
KAMP, AARON R DDS
PASCAGOULA
MS
00121650
1962445031
KAMP, PETER S
HATTIESBURG
MS
04978239
1013158013
KANAKAMEDALA, MADHAVA R MD
JACKSON
MS
00014934
1295754372
KANDOLA, JASWINDER S
PASCAGOULA
MS
00400053
1437533098
KANDRA, KALYAN C MD
JACKSON
MS
04707333
1437416542
KANDURI, SWETHA R MD
JACKSON
MS
05024859
1063889632
KANG, MIN JUNG S PMHNP
JACKSON
MS
00111731
1124050950
KANOSKY, MICHAEL G
FLOWOOD
MS
07875097
1639321326
KANSAGRA, KAVITA B MD
OLIVE BRANCH
MS
09470024
1184803660
KAPLAN, JULIE D MD
JACKSON
MS
03870709
1932361979
KARABELL, ANA H MD
SOUTHAVEN
MS
02474268
1215192406
KARAM, SIMON E MD
JACKSON
MS
05426707
1194810408
KARCHER, CHRISTOPHER P MD
OCEAN SPRINGS
MS
09137524
1881989911
KAREL, ASHLEY L NP
VICKSBURG
MS
00114839
1275562464
KARIM, PARVEZ MD
GREENVILLE
MS
02273838
1992903355
KARIM, SHABANA C MD
GREENVILLE
MS
06257806
1477993897
KARLAPATI, SURYA K MD
JACKSON
MS
03954314
1932223542
KARPITSKAYA, YEKATERINA MD
BILOXI
MS
00125255
1639148471
KARSTENS, ALLEN MD
SAUCIER
MS
02632308
1841318003
KASAPIS, CHRISTOS MD
MCCOMB
MS
00121591
1497708077
KASPER, KENNETH C MD
OLIVE BRANCH
MS
05270371
1942615562
KASUNDRA, SHYAM P
TUPELO
MS
05556509
1396760617
KATHAWALA, ARIFA MD
SOUTHAVEN
MS
00258041
1851666150
KATHMANN, BRETT S MD
GULFPORT
MS
162
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09580321
1699756320
KATZ, HOWARD T MD
JACKSON
MS
07887213
1538454236
KATZENMEYER, AARON
MADISON
MS
03932311
1396792578
KAUL, ARVINDER MD
LAUREL
MS
05208846
1548657091
KAUR, JASWINDER MD
JACKSON
MS
03551501
1740391390
KAVANAGH, JOEL B MD
GULFPORT
MS
09239033
1679615454
KAYE, GAYLA G NNP
FLOWOOD
MS
00125084
1326063900
KAYOMA, JOHN B
GREENVILLE
MS
06459345
1417397738
KAZIMIRKO, DMITRIY N MD
JACKSON
MS
00880031
1053404012
KEA, JOE C OD
TUPELO
MS
00121130
1568449536
KEADY JR, DWIGHT S MD
PHILADELPHIA
MS
04126702
1063887123
KEADY, AISHIA L FNP
PHILADELPHIA
MS
00124918
1285632943
KEBERT, KENT L MD
MCCOMB
MS
09608064
1629476197
KEBERT, LYNN S OD
MCCOMB
MS
01374098
1578655767
KEEL JR, M BERT DMD
BAY ST LOUIS
MS
02858227
1275760126
KEEL, MURRAY E DDS
BILOXI
MS
01880393
1285815589
KEELER, GARY D DDS
FLOWOOD
MS
00123629
1801826474
KEELER, SCOTT A MD
HATTIESBURG
MS
04227744
1932460508
KEELING, LISA M MD
FLOWOOD
MS
06075791
1679823090
KEETH, LACEY D FNP C
NATCHEZ
MS
06386869
1659578052
KEETON, KEVIN L MD
HATTIESBURG
MS
00120385
1760564801
KEIMIG, KATHY J MD
GULFPORT
MS
08508350
1578746285
KEITH, BRANDI B FNP
DECATUR
MS
00118930
1609849108
KEITH, JANA R
HATTIESBURG
MS
00125348
1073539409
KEITH, LAURA N ANP
HATTIESBURG
MS
07973545
1023555190
KEITH, STEPHANIE S PA
MADISON
MS
04829713
1457332066
KEITH, STEPHEN P MD
MCCOMB
MS
07555001
1588725519
KELLEHER, INEZ M MD
GULFPORT
MS
00124276
1346207362
KELLER, CANDACE MD
JACKSON
MS
163
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00653862
1295963791
KELLER, CURTIS M MD
BILOXI
MS
00084714
1639176472
KELLER, VERN A MD
JACKSON
MS
05450270
1780068056
KELLEY, AMELIA M PM HN
MERIDIAN
MS
03306258
1427004704
KELLEY, MARK C
GRENADA
MS
00121009
1609815000
KELLOUGH, KENNETH W
CLARKSDALE
MS
00011168
1427055185
KELLUM, ANDREW H MD
TUPELO
MS
00124083
1508836032
KELLUM, KENNETH M
TUPELO
MS
00115205
1881665859
KELLUM, MARK J
TUPELO
MS
05854215
1679543102
KELLUM, RONALD F MD
DIAMOND HEAD
MS
00119403
1326181421
KELLUM, ROY B
JACKSON
MS
00753273
1124228754
KELLUM, ROY B MD
FLOWOOD
MS
00126714
1366556557
KELLY MD, SCOTT M
CANTON
MS
02639231
1457457814
KELLY, AMANDA J CFNP
FULTON
MS
01007241
1619321668
KELLY, BRANDON M MD
JACKSON
MS
00117294
1104895267
KELLY, CHARLES S
FULTON
MS
04951036
1649499971
KELLY, DEREK M MD
SOUTHAVEN
MS
00011284
1255462230
KELLY, GRACE P MD
MERIDIAN
MS
04404071
1700812740
KELLY, JOSEPH B MD
COLUMBUS
MS
05370311
1396148409
KELLY, KARLEE E FNP
GREENWOOD
MS
08138363
1023092533
KELLY, MARILYN R FNP
BOONEVILLE
MS
00124357
1457394090
KELLY, MARK A
LAUREL
MS
05824748
1598191298
KELLY, PENNY L CNP
JACKSON
MS
00687511
1659507564
KELLY, SARAH D FNP
HATTIESBURG
MS
08109243
1013282961
KELLY, SHENIKA S DMD
MERIDIAN
MS
00123588
1629026596
KELLY, THOMAS J DO
BRANDON
MS
07339341
1992815625
KEMP, ANN M MD
JACKSON
MS
00115766
1396727590
KEMP, JENNIFER R NP
ASHLAND
MS
07382829
1992120158
KEMP, LINDSAY A CFNP
COLUMBUS
MS
164
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118248
1548204746
KEMP, STEPHEN F
JACKSON
MS
08334267
1700172327
KENCY JR, FRED E MD
JACKSON
MS
02581273
1720375389
KENCY, JASMINE T MD
JACKSON
MS
00110338
1700991288
KENDRICK, LELAND R MD
WAVELAND
MS
00733373
1275912065
KENNARD, JENNIFER L DO
JACKSON
MS
00112364
1144263062
KENNEDY JR, JOHN L MD
WHITFIELD
MS
09837821
1437560281
KENNEDY, DANIEL P MD
JACKSON
MS
01031064
1457449589
KENNEDY, EDWIN J MD
FLOWOOD
MS
01936790
1780095851
KENNEDY, JOSHUA K DO
JACKSON
MS
00116208
1689725202
KENNEDY, RONALD E MD
JACKSON
MS
08608857
1497836704
KENNETH JOHNSON DDS
TUPELO
MS
00153870
1477935039
KENNY, AMY R DMD
GULFPORT
MS
07227839
1467423475
KENT, ROBERT M MD
OLIVE BRANCH
MS
00115703
1417061250
KENT, RONALD S
HATTIESBURG
MS
00112473
1104844505
KERBY, ANDREW L MD
CORINTH
MS
07885561
1730268939
KERBY, SEAN C
GULFPORT
MS
00123167
1932177193
KERGOSIEN, CAROLYN P
SAUCIER
MS
00118411
1619087541
KERGOSIEN, CHARLES A MD
BROOKHAVEN
MS
00019189
1730109018
KERGOSIEN, WILLIAM E MD
GULFPORT
MS
03039557
1518197151
KERR, PAUL B MD
JACKSON
MS
03778797
1700016359
KERSEY, KELLY A MD
TUPELO
MS
00118827
1679687420
KERSH, JANE E MD
HATTIESBURG
MS
00124654
1861445108
KERSTEN, KEITH A
HATTIESBURG
MS
05926061
1508245622
KERUT, SARAH E MD
JACKSON
MS
00120441
1932130127
KERUT, TIMOTHY P MD
VICKSBURG
MS
09559315
1760496228
KESSEY, RICHARD K MD
STARKVILLE
MS
04378217
1295117505
KETCHUM, ANNA NP
JACKSON
MS
06980598
1932527967
KEYS, BRIDGET D FNP
LAUREL
MS
165
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03320311
1497187512
KEYS, FELICIA R NP
LAUREL
MS
04187246
1497762256
KEYS, GRETA L FNP
PRENTISS
MS
04534794
1639510142
KEYS, JOSEPH C NP
WIGGINS
MS
06453391
1225340557
KHAIRE, SUSHANT S MD
JACKSON
MS
00905368
1679702302
KHALID, AYESHA MD
JACKSON
MS
03032215
1467671677
KHALIQ, FAZILA MD
SOUTHAVEN
MS
04635763
1689679441
KHAMAPIRAD, TAWAN S MD
CORINTH
MS
06523572
1396761185
KHAN, MAJID A MD
JACKSON
MS
00118746
1861401127
KHAN, TARIQ A MD
SOUTHAVEN
MS
09652558
1194925032
KHAN, ZARRISH S MD
GREENVILLE
MS
07408359
1184643686
KHANDEKAR, ZINAT R
WHITFIELD
MS
00116487
1962437582
KHANSUR, NUSRAT J MD
JACKOSN
MS
00117557
1659381044
KHAWAJA, AKIF A MD
WHITFIELD
MS
05270379
1790130763
KHAWAJA, NIDA MD
JACKSON
MS
08600808
1396922977
KHEMKA, DEEPAK MD
HATTIESBURG
MS
00376874
1457509903
KHEMKA, MANPREET MD
HATTIESBURG
MS
00120919
1548241904
KHIMENKO, PAVEL L MD
PASCAGOULA
MS
02938575
1659733608
KHOSHROO, SOHIEL M DO
JACKSON
MS
00115813
1144225632
KIEHN, ROBERT K DO
MERIDIAN
MS
01680750
1376993394
KIJONKA, ERIN H NP
GULFPORT
MS
04177049
1750799300
KIKER, EMILY NP
FLOWOOD
MS
05859009
1588895080
KIKER, MELISSA D FNP
MERIDIAN
MS
00870268
1093122210
KILDOW, JOYCE D PA
OLIVE BRANCH
MS
00119198
1265514301
KILLEBREW, LARRY H MD
GULFPORT
MS
00111588
1881636306
KILLINGS, KAYE NP
JACKSON
MS
02485706
1144457284
KILMAN, BENTON E MD
FULTON
MS
03286518
1831500818
KILMAN, CHLOE A MD
JACKSON
MS
07374555
1225449317
KILPATRICK, DAVID L MD
JACKSON
MS
166
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06775267
1881146306
KILPATRICK, KIMBERLY R NP-C
HOLLANDALE
MS
03205061
1457337818
KIM, HYUNG W MD
JACKSON
MS
08105201
1437187333
KIM, MIN S MD
COLUMBUS
MS
09601580
1922482322
KIM, PATRICK Y MD
JACKSON
MS
05137067
1427357847
KIM, WOO S MD
LAUREL
MS
00126141
1235145269
KIM, YONG W
JACKSON
MS
09353242
1922073840
KIMBALL, NOAH B MD
OLIVE BRANCH
MS
07003821
1477915718
KIMBERL, JOHANNA M PA-C
VICKSBURG
MS
02675521
1093796328
KIMBRELL, HOLLY L CFNP
BROOKHAVEN
MS
06026233
1275892705
KIMBRELL, JILLIAN F CNP
PASCAGOULA
MS
06453341
1104231695
KIMBROUGH, KYLE W PA
JACKSON
MS
00122590
1144363235
KIMMEL, EDRA S
FLOWOOD
MS
08474728
1710061403
KIMMONS, JAMES E DDS
FLOWOOD
MS
06333880
1386897635
KINABREW, NAKECIA D
FLOWOOD
MS
02339383
1376740803
KINARD, KIRK L DO
SOUTHAVEN
MS
03882723
1265809685
KINCAID, BRYCE D NP
JACKSON
MS
00121589
1881688828
KINCH, DIAN J MD
WEST POINT
MS
01154595
1508084005
KINDL, BRIAN T MD
MCCOMB
MS
02581770
1043324809
KING III, THOMAS E MD
HATTIESBURG
MS
02572058
1669576989
KING MACNEIL, THERESA R FNP
BROOKHAVEN
MS
05207250
1104851161
KING, CHARLENE D DNP
PORT GIBSON
MS
00116725
1538137989
KING, CHARLES M MD
TUPELO
MS
08789502
1891810396
KING, DANNETTE N OD
OCEAN SPRINGS
MS
09137314
1255409173
KING, DELETHA M FNP
FLOWOOD
MS
02573051
1669779021
KING, DUSTIN L MSN
JACKSON
MS
08884077
1598865511
KING, HEATHER T NP
JACKSON
MS
04825058
1861505448
KING, JOHN J MD
COLUMBUS
MS
02288352
1902217086
KING, JOY F MD
JACKSON
MS
167
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05172325
1285068270
KING, KELLI D CNP
COLUMBUS
MS
01384559
1679857932
KING, LARA N FNP
MERIDIAN
MS
00606221
1801179791
KING, LAURA C NP
BROOKHAVEN
MS
07486872
1720456700
KING, LEANNA D NP
NEW ALBANY
MS
03173788
1811342124
KING, MADELYN B MD
JACKSON
MS
03659286
1861420978
KING, MADELYN B NP
COLUMBUS
MS
00126569
1730143009
KING, MARY A DO
AMORY
MS
06707899
1699099911
KING, MICHAEL D NP
PONTOTOC
MS
00016134
1548423718
KING, PAUL MD
SOUTHAVEN
MS
04158289
1609872704
KING, PAUL D MD
SOUTHAVEN
MS
06387203
1780709279
KING, PHILLIP L OD
OCEAN SPRINGS
MS
02570566
1942396445
KING, ROBERT C PA-C
MERIDIAN
MS
01657061
1013330109
KING, TINA M FNP-C
TUPELO
MS
02937253
1679709174
KING, WILLIAM H MD
OXFORD
MS
01784238
1336376953
KINGET, HOLLY M MD
HATTIESBURG
MS
04202037
1669775581
KINSEY, CYNTHIA NP
OCEAN SPRINGS
MS
04083531
1821336595
KIRBY, BRIAN C DPT
STARKVILLE
MS
02125899
1629291919
KIRK, HENRY A MD
OXFORD
MS
05156567
1407957632
KIRK, KECIA
OXFORD
MS
05130811
1679756084
KIRKLAND, PATRICK J MD
MERIDIAN
MS
01058872
1326593153
KIRKLAND, SHANNON D FNP
PHILADELPHIA
MS
00015278
1013002997
KIRKSEY, ROBERT C MD
TUPELO
MS
02973751
1093800997
KIRKSEY, WILLIAM M MD
TUPELO
MS
02678344
1740400506
KIRMSE, BRIAN M MD
JACKSON
MS
06788221
1336191246
KISER, KENNETH D MD
RICHTON
MS
05605321
1912242462
KISHORE, SHWETA MD
JACKSON
MS
00121824
1053369355
KITCHENS BOYANTON, AMANDA CRNA
JACKSON
MS
00123644
1912979592
KITCHENS, BEN E MD
IUKA
MS
168
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00124573
1952444754
KITTRELL JR, JIMMY L MD
PICAYUNE
MS
00038057
1033536545
KITZ III, ROBERT J MD
MERIDIAN
MS
01822863
1184893463
KITZMAN, GEOFFREY A MD
JACKSON
MS
00339060
1376542233
KLAR, ANGELLE L MD
JACKSON
MS
05903007
1184887663
KLAR, PATRICK M MD
JACKSON
MS
06352389
1881635225
KLEIN, LANCE NP
FLOWOOD
MS
00125529
1376628529
KLEIN, MARK MD
FLOWOOD
MS
00432311
1427045194
KLOEK, SCOTT M MD
SOUTHAVEN
MS
08736735
1225576820
KLOTZBACH, CONNIE PA
OCEAN SPRINGS
MS
01933708
1487855300
KNEIP, CHRISTOPHER J MD
FLOWOOD
MS
00060414
1043376023
KNIGHT, EDWARD S
CORINTH
MS
00660117
1073685830
KNIGHT, JEFFREY L DDS
GAUTIER
MS
00016869
1831117019
KNIGHT, JOEL M MD
BILOXI
MS
05401590
1023319936
KNIGHT, KISHA L NP-C
SEMINARY
MS
05106295
1225143746
KNIGHT, LAMAR V DDS
JACKSON
MS
05907262
1720520562
KNIGHT, MACK E FNP-C
MOSELLE
MS
04951293
1730123142
KNIGHT, RUSSELL A MD
MERIDIAN
MS
04807555
1083852131
KNIGHT, SARA NP
BOLTON
MS
05173045
1124576707
KNIGHT, URSULA M NP
MOSS POINT
MS
02052873
1922394469
KNIGHT-STARLING, DAPHENIA C ANP
JACKSON
MS
00127061
1386658763
KNOTT, CATHERINE W CFNP
BROOKHAVEN
MS
05634545
1245691161
KNOTT, ZACKARY A MD
JACKSON
MS
05239768
1912359415
KNOTTS, MICHAEL P NP
PASCAGOULA
MS
09157861
1265982417
KNOWLES, KELVIN K FNP-C
MERIDIAN
MS
01520708
1982623393
KNOWLTON, SUSAN F KNOWL
PICAYUNE
MS
05583595
1477509743
KNOX, BRUCE R MD
NATCHEZ
MS
04654202
1447578455
KNUDSON, JARROD D MD
JACKSON
MS
00123893
1821127804
KO, MIKE K MD
GREENWOOD
MS
169
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08778058
1841590908
KOBAISY, MAISARA MD
OXFORD
MS
06936861
1033156187
KOCH, CHRISTIAN A
JACKSON
MS
00115971
1366459976
KOE, FRANK G MD
JACKSON
MS
00122193
1710955984
KOEHLER, KEVIN R
TUPELO
MS
02821764
1528316395
KOEPP, BONNIE S FNP
VICKSBURG
MS
06121562
1811086515
KOGON, BRIAN E MD
JACKSON
MS
09151034
1912391889
KOHLI, DISHA MD
JACKSON
MS
02553027
1710315387
KOHLIEM, CYNTHIA R NP
TUPELO
MS
05658870
1639331622
KOHUT JR, ROBERT M MD
BILOXI
MS
05435572
1477500676
KOKAISEL, KERRY L NP
JACKSON
MS
02858713
1174533178
KOKKO, KENNETH E MD
JACKSON
MS
03988544
1285086504
KOLAWOLE, JOHN O MD
JACKSON
MS
00014346
1629008396
KOLB, JAMES
JACKSON
MS
08228861
1831504877
KOMMISETTI, VEERA V MD
JACKSON
MS
00118355
1942234596
KONKLE-PARKER, DEBORAH D NP
JACKSON
MS
00651562
1457658544
KOROSCIL, MICHAEL MD
BILOXI
MS
08520364
1356551691
KOSEK, KEVIN A MD
JACKSON
MS
00119013
1124069638
KOSEK, MARY A
JACKSON
MS
06982507
1639248099
KOSKAN JR, ALLEN J MD
BILOXI
MS
00018846
1831197862
KOSKAN, IRENE K MD
GULFPORT
MS
06621790
1295937928
KOSKO, JOHN H MD
HATTIESBURG
MS
05676593
1104107036
KOSKO, MAMIE M NP
COLUMBUS
MS
05508385
1447578752
KOSKO, MARK G MD
JACKSON
MS
00124166
1144334814
KOT, JAMES B MD
HATTIESBURG
MS
00124423
1962516641
KOT, LIBBY MD
HATTIESBURG
MS
00118184
1942298120
KOTFILA, RONALD P MD
FLOWOOD
MS
06007531
1124069521
KOTIKALAPUDI, SIVARAMA K MD
HATTIESBURG
MS
08326718
1689870479
KOTTI, GEORGE H MD
GULFPORT
MS
170
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00010679
1225143910
KOURY, ALBERT M MD
JACKSON
MS
00801328
1326277427
KOURY, MICHAEL W MD
VICKSBURG
MS
08382811
1912374174
KOVALICK, ASHLI D FNP
TUPELO
MS
01550007
1639482821
KOVVURU, KARTHIK MD
GREENWOOD
MS
05421720
1437599842
KOWALCZYK, DAVID M MD
JACKSON
MS
00120749
1265486450
KPABITEY, EMMANUEL T MD
BOONEVILLE
MS
06230562
1730593989
KRAMER, ERIN S CPNP
PASCAGOULA
MS
00123983
1144337155
KRASIN, AUDREY L MD
SENATOBIA
MS
00114534
1225142920
KRATZ, KURT G
HATTIESBURG
MS
02924391
1669762902
KREHER, STACEY M WHNP
BAY ST LOUIS
MS
00117431
1629060041
KRENTEL, ROD G MD
GULFPORT
MS
01150325
1144614603
KRIEDERMANN, JACOB L DO
JACKSON
MS
03658572
1972720381
KRIEG, JOHN R MD
BILOXI
MS
06382543
1558701706
KRISHNA, CHANDRA K MD
OXFORD
MS
00016033
1033142724
KRONFOL, N O MD
GREENVILLE
MS
00015628
1588653901
KROOSS, II, WILLIAM F
PEARL
MS
08876201
1215920855
KRUSE, JOHN J MD
HATTIESBURG
MS
00125730
1336277227
KUHLMANN, DAVID M MD
GULFPORT
MS
00122982
1891833828
KULPA, JANUW MD
OCEAN SPRINGS
MS
08251582
1497061915
KUMAR, ADITI MD
JACKSON
MS
01585512
1154403962
KUMAR, ALOK MD
SOUTHAVEN
MS
02176581
1174842330
KUMAR, HAMIT MD
LAUREL
MS
00118829
1366544603
KUMAR, PARVEEN MD
RIDGELAND
MS
07574002
1881991743
KUMAR, SUNIL MD
PHILADELPHIA
MS
00127127
1770945073
KUMAR, VARSHA MD
JACKSON
MS
00118246
1417969338
KUMI, KOFI MD
NATCHEZ
MS
05722201
1366630931
KUO, JEFFREY S MD
VICKSBURG
MS
06807020
1346582178
KURDI, YAHYA M MD
TUPELO
MS
171
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09838050
1609181882
KURIGER, HEATHER M FNP
BRANDON
MS
04628251
1902102668
KURNUTALA, LAKSHMI N MD
JACKSON
MS
01681707
1821153388
KURTS, JENNY C CFNP
GREENVILLE
MS
09827742
1215164769
KUSEMIJU, OLADIPO A MD
PICAYUNE
MS
07331276
1255573812
KUTCHER, MATTHEW E MD
JACKSON
MS
09379098
1891050548
KUYKENDALL, AMELIA NP
TUPELO
MS
00126737
1477582096
KWENTUS, JOSEPH A MD
JACKSON
MS
00476310
1760411813
KWOK, WARREN MD
OLIVE BRANCH
MS
06885280
1134393473
KYAW, YADANA MD
SOUTHHAVEN
MS
00120849
1366489296
KYZAR, KENT C
MCCOMB
MS
00119505
1669454690
LABONTE, ROGER S MD
MERIDIAN
MS
09335562
1982833091
LACEY, LANISE C ACNP
JACKSON
MS
00880116
1639198203
LACEY, ROBERT R OD
ABERDEEN
MS
02306524
1568895704
LACHNEY, RICHMOND P FNP
PHILADELPHIA
MS
02486282
1982691465
LACY, MICHAEL R MD
SOUTHAVEN
MS
02225870
1013068469
LACY, PAMELA MD
AMORY
MS
07787063
1821545757
LADD, AMANDA L CNP
HATTIESBURG
MS
02102891
1922049980
LADNER, CHRISTINE A
HATTIESBURG
MS
02076269
1346589421
LADNER, JENNAH C FNP
GULFPORT
MS
04507528
1487753562
LADNER, MARK E MD
HATTIESBURG
MS
01900566
1740549781
LADNER, RAVEN S MD
GULFPORT
MS
01583061
1922374057
LADNER, TONI L PMHNP
GULFPORT
MS
09330877
1003239294
LADNER, TRACY L NP
GULFPORT
MS
00951863
1992254239
LAFAYETTE, MINDY NP
BATESVILLE
MS
01525332
1578874913
LAFFERTY, CASEY E DO
DEKALB
MS
07206011
1710130943
LAFFERTY, JENNIFER P FNP
MARION
MS
03638586
1801167671
LAFLEUR, ABIGAIL M FNP
DIAMONDHEAD
MS
01807273
1558370254
LAFLEUR, NICOLE A MD
BAY SAINT LOUIS
MS
172
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00483746
1770975815
LAFRANCE, ELISA S NP
DIAMONDHEAD
MS
00124384
1922049238
LAGARDE, THOMAS E M.D.
FLOWOOD
MS
08129845
1265453112
LAGE, JANICE M MD
JACKSON
MS
06507067
1548294580
LAHR, CHRISTOPHER J MD
JACKSON
MS
03109592
1477676831
LAI-VELEZ, MICHELLE Q MD
LUMBERTON
MS
01103046
1255775417
LAILA, TAIYAMUM MD
OXFORD
MS
07680026
1770532582
LAIRD, EMILY R NP
FLOWOOD
MS
00013555
1285659664
LAKE JR., CHESTER H
OXFORD
MS
09335267
1235421165
LAKES, CLAIRE M APRN
PASCAGOULA
MS
05034060
1649425596
LALA, ASIF A DMD
MERIDIAN
MS
01880521
1821013012
LAM, JOHN T MD
JACKSON
MS
04222580
1407866650
LAM, SON G MD
NEWTON
MS
09581514
1447565700
LAMAR, STEPHANIE D NP
SOUTHAVEN
MS
01901349
1952357378
LAMB, TIMOTHY H DO
OXFORD
MS
08871366
1043269236
LAMBERT, BRANDI J ANP
BOONEVILLE
MS
00118441
1144267113
LAMBERT, BUFORD L MD
NEW ALBANY
MS
07676773
1861758898
LAMBERT, EDITH NP
JACKSON
MS
06229807
1568813558
LAMBERT, JOHN C FNP
BROOKHAVEN
MS
00118768
1528171758
LAMBERT, PHILLIP N
CLEVELAND
MS
00117339
1851395479
LAMBERT, STEPHEN C MD
HATTIESBURG
MS
00063490
1093867657
LAMBERT, TERRY A DDS
HATTIESBURG
MS
01334344
1861663460
LAMBERT, VICKI M FNP
BALDWYN
MS
06927360
1982155057
LAMBERT, VICKIE L ACNP
CORINTH
MS
00118389
1831194364
LAMISON, LINDA W
COLUMBUS
MS
02588834
1043227606
LAMOUSIN, JAMES C
PURVIS
MS
00112121
1295828614
LAMPTON, BRETT C MD
OXFORD
MS
00112122
1689781007
LAMPTON, LUCIUS M MD
MAGNOLIA
MS
09484753
1497796536
LANASA III, JAMES E MD
BAY SAINT LOUIS
MS
173
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01478721
1619952918
LANCIERS, SOPHIE MD
JACKSON
MS
00120913
1013008242
LANCON, JOHN A MD
JACKSON
MS
00124222
1154369700
LAND, KELLY K NP
JACKSON
MS
05870208
1477803252
LANDIS, HOPE E NP
GULFPORT
MS
01704567
1861620676
LANDON, THOMAS E FNP
BILOXI
MS
02078311
1780078253
LANDRY, JR, EDWARD P MD
JACKSON
MS
00060140
1063503126
LANDRY, RALPH J DDS
CLARKSDALE
MS
03438577
1811376007
LANE, JENNA K MD
JACKSON
MS
07184351
1720185754
LANEHART, JENNIFER FNP
WOODVILLE
MS
08953258
1396134482
LANEY, ALLISON NP
LONG BEACH
MS
07425565
1184823551
LANEY, CHARLES A MD
OXFORD
MS
09739109
1760746150
LANGE, JESSICA L MD
JACKSON
MS
00727328
1942668785
LANGHAM, SARAH R NP
JACKSON
MS
06350548
1750798344
LANGLEY, CHRISTIAN C FNP-B
LAUREL
MS
04576590
1407853401
LANGLOW, EDWARD P MD
GULFPORT
MS
05289081
1376623744
LANGSTON, CATHERINE J DO
JACKSON
MS
03887308
1285097030
LANGSTON, GILES D MD
JACKSON
MS
05920341
1922218957
LANGSTON, LEDON MD
BROOKHAVE
MS
09629565
1356585244
LANGSTON, SANDRA S
JACKSON
MS
00118271
1205825643
LANIER JR, DOUGLAS C
GULFPORT
MS
02639008
1265831184
LANNING, LEILA M MSN
JACKSON
MS
07526882
1043420383
LANSDOWN, CHRISTOPHER E MD
BILOXI
MS
00126008
1215942248
LANTRIP, BRYAN S
JACKSON
MS
00125197
1477594851
LANTRIP, DANNY D CFNP
HOUSTON
MS
03778863
1902052954
LAPIN, DONISHA D FNP-B
CORINTH
MS
07801349
1538354030
LAPRAD, DEBRA L MD
OCEAN SPRINGS
MS
08486041
1053567313
LARES, CLAUDIA G MD
JACKSON
MS
03530077
1013056555
LARKIN, MARY R MD
MERIDIAN
MS
174
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05126078
1316256142
LARMOUR, WILLIAM C NP
COLUMBUS
MS
00115286
1740228253
LAROCHELLE, MICHAEL D DO
TUPELO
MS
00120612
1497860670
LAROSA JR, DAVID V MD
GULFPORT
MS
00231081
1639391097
LAROSE, SHARON T
BILOXI
MS
09107213
1659615557
LARRY, ZENOTHA WHNP
JACKSON
MS
06105593
1144301458
LARSEN, ASHLEY J PA
OCEAN SPRINGS
MS
09059224
1861672909
LARSEN, JILL R PA
PASCAGOULA
MS
00836531
1740601137
LARSON, CAMERON DMD
PASCAGOULA
MS
03974021
1083788665
LARY, VICKI N FNP
GREENWOOD
MS
00118315
1710095880
LASETER, JEFFREY T
FLOWOOD
MS
03282809
1356638613
LASLEY, CARA J DO
JACKSON
MS
02223785
1225325632
LASSITER, LINDSEY NP
JACKSON
MS
02505046
1205082138
LATCH, KATHRYN N OD
OCEAN SPRINGS
MS
07081851
1295931145
LATHIA, VIRAL N MD
HATTIESBURG
MS
00087927
1467675983
LATIMER, TOMMY OD
PHILADELPHIA
MS
05475501
1104088152
LATORRE, CARLOS A MD
VICKSBURG
MS
06180375
1508247560
LATOUR, CHRISTOPHER A MD
JACKSON
MS
00118108
1508838681
LATOUR, LYDIA F MD
OCEAN SPRINGS
MS
03650578
1093095523
LAUDERDALE, JESSICA A
TUPELO
MS
01224050
1275664732
LAUDERDALE, REBECCA W MD
HATTIESBURG
MS
00114338
1700851615
LAURENZO, JOHN
OXFORD
MS
01131860
1467711408
LAVENDER, JESSICA S MD
JACKSON
MS
00121159
1346238540
LAWIN, PENNY J MD
JACKSON
MS
00921061
1609100536
LAWRENCE, JESSICA J FNP
PONTOTOC
MS
03338302
1063475440
LAWRENCE, KATHY O FNP
KOSCIUSKO
MS
01684335
1649536335
LAWRENCE, ROXANNE S DMD
JACKSON
MS
00110164
1851330500
LAWRENCE, WILLIAM K MD
OXFORD
MS
06939708
1639467921
LAWS, RASHANDRA F NP
JACKSON
MS
175
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00119790
1003817982
LAWSON, ERIC D MD
GULFPORT
MS
00116332
1811083785
LAWSON, LOUISA E MD
JACKSON
MS
00121949
1780615633
LAWSON, NATHANIEL
JACKSON
MS
08482749
1851744163
LAWSON, NICKI E NP
JACKSON
MS
00122611
1578582417
LAWSON, SAMUEL T MD
JACKSON
MS
05779090
1003170325
LAWYER, TRACYE J MD
JACKSON
MS
00115194
1144338369
LAY JR, A K MD
BAY SPRINGS
MS
03208527
1093109316
LAY, JUSTIN M DO
JACKSON
MS
00119599
1922106749
LAYNE, SCOTT C M.D.
JACKSON
MS
01651210
1861876310
LEA, ROSANNA
BRANDON
MS
08924001
1962543876
LEACH, JASON A DMD
HORN LAKE
MS
00476391
1760615595
LEACH, SHELLEY S NP
NEW HEBRON
MS
00115279
1508970211
LEADER, LAWRENCE J
HATTIESBURG
MS
00018128
1427086636
LEAK, JAMES C
GLOSTER
MS
00112590
1124179767
LEAKE, LAWRENCE A
PASCAGOULA
MS
07304052
1821033382
LEATH, SARAH J NP
WHITFIELD
MS
09726757
1548460629
LEATHERBURY, CLIFTON T
GULFPORT
MS
02458236
1154367738
LEATHERMAN, BRYAN MD
GULFPORT
MS
09701839
1780775619
LEATHERS, BREANNE N FNP
HATTIESBURG
MS
00114491
1750342986
LEATHERWOOD, LYNN E MD
GULFPORT
MS
09975030
1679837066
LEBLANC, STEPHEN B MD
JACKSON
MS
03803212
1750621900
LEBLEU, AMITY M ACNP
OCEAN SPRINGS
MS
00125750
1649226317
LEBRUN, CHRISTOPHER
COLUMBUS
MS
00125648
1861461378
LECKIE, CHARLES E MD
ECRU
MS
02756771
1922544915
LEDFORD, SCOTIE M FNP
JACKSON
MS
05789559
1881708568
LEDOUX, WILLIAM R DDS
BAY ST LOUIS
MS
00117036
1912079161
LEDUFF, JEFFREY K MD
JACKSON
MS
07435869
1700838232
LEE III, MARVIN MD
HATTIESBURG
MS
176
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08377066
1730407982
LEE III, PRESTON H DDS
SENATOBIA
MS
08387339
1417320102
LEE, ALLISON H NP-C
TUPELO
MS
00908521
1801979703
LEE, ANN M MD
BRANDON
MS
02327202
1194076836
LEE, APRIL L CNP
CANTON
MS
00605263
1083012132
LEE, CENEDRA D NP
JACKSON
MS
01428215
1649391616
LEE, CHRISTOPHER E MD
JACKSON
MS
09924066
1538485271
LEE, DANIEL A MD
SOUTHAVEN
MS
00123883
1316048911
LEE, DAVID C MD
HATTIESBURG
MS
00660459
1942354147
LEE, DAVID H DMD
GREENVILLE
MS
01304745
1912358656
LEE, ELLEN B D.M.D
GREENVILLE
MS
04058512
1609137868
LEE, ELLEN C NP
JACKSON
MS
04884247
1780137703
LEE, EUN C DDS
GULFPORT
MS
01935598
1033531512
LEE, JERMONIQUE S FNP-C
FAYETTE
MS
00116049
1992806699
LEE, JOHN P MD
FOREST
MS
03509353
1689815664
LEE, JOHNATHAN Y MD
MERIDIAN
MS
02832791
1174904361
LEE, JONATHAN D MD
JACKSON
MS
00122888
1134128077
LEE, JOSEPH R MD
BAY ST LOUIS
MS
00010520
1205806155
LEE, JR, JOHN M MD
TUPELO
MS
06576706
1386930477
LEE, KAREN NP
HATTIESBURG
MS
07324562
1790138873
LEE, KATHERINE E PMHNP
TUPELO
MS
00112670
1467470799
LEE, KERRY T MD
GRENADA
MS
06673353
1013951854
LEE, LYNDELL S FNP
HATTIESBURG
MS
00119400
1093887259
LEE, MAKAU P MD
FLOWOOD
MS
01278226
1104243195
LEE, MARCIE A NP-C
GULFPORT
MS
01931896
1689870982
LEE, MARCUS W
JACKSON
MS
01036293
1841429602
LEE, NICOLE M MD
JACKSON
MS
00018444
1497898027
LEE, PERCY M
FLOWOOD
MS
00632581
1770594368
LEE, PHILIP S MD
MACON
MS
177
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08104728
1689925893
LEE, REGINA FNP
LAUREL
MS
04731740
1043623515
LEE, RICHARD E MD
JACKSON
MS
00118602
1285785709
LEE, ROBERT MD
OCEAN SPRINGS
MS
00087884
1649487596
LEE, ROBERT E OD
JACKSON
MS
04402871
1063848075
LEE, ROWDY C PA-C
HATTIESBURG
MS
06788293
1255427696
LEE, STEPHEN F MD
FLOWOOD
MS
00112101
1134158579
LEE, ZINA D MD
CORINTH
MS
03604786
1275995227
LEECH, JOSEPH D DO
JACKSON
MS
00119541
1841284767
LEEK, GRIF A
HATTIESBURG
MS
00119543
1710971635
LEEK, LISA L
HATTIESBURG
MS
03937860
1659731107
LEGG, MAGAN N NP
MCCOMB
MS
00060256
1962512251
LEGGETT JR, HUGH V DDS
BROOKHAVEN
MS
00121599
1093791956
LEGGETT, DAVID C MD
OLIVE BRANCH
MS
07624895
1801100037
LEGGETT, JENNIFER R NP
MT. OLIVE
MS
00925851
1700128535
LEGGETT-KING, RACHEL
JACKSON
MS
00122443
1528034774
LEGNON, RICHELLE C M.D.
PICAYUNE
MS
00660214
1407959810
LEHAN, CORNELIUS C
CLINTON
MS
00018904
1467551168
LEHMAN, THOMAS W MD
GULFPORT
MS
00013086
1295896884
LEIGH, JOE N
HATTIESBURG
MS
00120817
1841302411
LEIS, ANGEL A MD
JACKSON
MS
06608789
1417946013
LEIS, HENRY T MD
GULFPORT
MS
02876000
1629302823
LEISTER, TIFFANY NP
OXFORD
MS
06471003
1295730224
LEMAY, THOMAS B MD
NATCHEZ
MS
00272061
1073953147
LENNEP, BRANDON W MD
JACKSON
MS
03071390
1538509955
LENNEP, DAY S MD
JACKSON
MS
04378509
1386639359
LENOIR, ERIC T PA
MCCOMB
MS
04324730
1154514578
LENOIR, MARJORIE M OD
MADISON
MS
00123016
1164589388
LENOX, VALERIE R MD
GULFPORT
MS
178
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08230097
1932651429
LEONE, LAURA C FNP
CANTON
MS
00012120
1720064108
LEPPERT, WILLIAM M
OLIVE BRANCH
MS
05923555
1184093189
LESLEY, KIRSTIE E MSN
JACKSON
MS
00060364
1861523748
LESLIE, ALTUS
CLEVELAND
MS
02557010
1124272893
LESLIE, LESLIE ACNP-
BATESVILLE
MS
06434044
1417202433
LESSLEY, JENNIFER L NP
NATCHEZ
MS
09103228
1225003098
LESSMANN, ERIK P MD
INDIANOLA
MS
01851204
1306271580
LESTER, ALENA A FNP
COLUMBUS
MS
01053864
1669607016
LESTER, SAMUEL R DMD
JACKSON
MS
07885571
1578901815
LESTRADE, ASHLEY M DDS
CARRIERE
MS
00111183
1700991205
LETARD, THOMAS P MD
GULFPORT
MS
03732771
1184737371
LETCHWORTH, TONY R NP
OLIVE BRANCH
MS
09028051
1063703809
LETELLIER, SCOTT M MD
JACKSON
MS
04377890
1023202272
LETORT, DEREK T MD
JACKSON
MS
00064979
1417164989
LETTERI, JOSEPH D DMD
LOUISVILLE
MS
07538740
1952734139
LEVERETTE, JILL CFNP
GRENADA
MS
00903514
1033309133
LEVESQUE, VANETTA L MD
JACKSON
MS
06252395
1619051877
LEVIN, PHILLIP L MD
GULFPORT
MS
04888802
1568401396
LEVY, ARTHUR MD
HAZELHURST
MS
00121874
1033117445
LEWIN, JACK R MD
JACKSON
MS
00120069
1982637831
LEWIS, ADAM I
FLOWOOD
MS
04603795
1720207509
LEWIS, ANDREA M MD
JACKSON
MS
00660038
1396920252
LEWIS, ERIC S DMD
MCCOMB
MS
07451813
1043229990
LEWIS, ERIC V MD
TUPELO
MS
00116617
1699724906
LEWIS, HENRY L MD
LIBERTY
MS
00112891
1821038407
LEWIS, JAMES R
TUPELO
MS
00932715
1548206501
LEWIS, JAMES W MD
AMORY
MS
00803385
1780911636
LEWIS, JENNIFER A MSN
JACKSON
MS
179
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00013560
1073536132
LEWIS, JOHN W
ROSEDALE
MS
02105756
1073055695
LEWIS, KAYLON CNP
HATTIESBURG
MS
01823221
1902017924
LEWIS, KYLE T MD
JACKSON
MS
05202077
1003043506
LEWIS, MATTHEW W MD
VANCLEAVE
MS
02556299
1427282854
LEWIS, MELODY B NP
FLOWOOD
MS
06453895
1568727352
LEWIS, PATRICIA L FNP-C
NEW ALBANY
MS
05374377
1033568431
LEWIS, PATRICIA L NP
OCEAN SPRINGS
MS
00237390
1154412534
LEWIS, RAMONICA
CLINTON
MS
00115504
1093752115
LEWIS, ROBERT L MD
NATCHEZ
MS
00124929
1205912946
LEWIS, ROSELINE K FNP
JACKSON
MS
08025742
1881797330
LEWIS, TERRILYN L FNP
MCCOMB
MS
09887263
1518323427
LEWIS, VIRGINIA P PMHNP
WHITFIELD
MS
00116045
1346341054
LEWIS, WILLIAM M MD
FOREST
MS
00019975
1972537041
LEWIS, WILLIE J DPM
JACKSON
MS
00116599
1790890499
LEY, PHILLIP B MD
FLOWOOD
MS
05483727
1811928625
LIBERATORE, HOLLY C MD
HATTIESBURG
MS
00115535
1649380536
LIBYS, JAY J MD
GULFPORT
MS
00118980
1518908326
LICK, CYNTHIA B
HATTIESBURG
MS
00015760
1023032497
LIDDELL, HAL T MD
HATTIESBURG
MS
06577053
1528473261
LIDDELL, MARSHEA S NP
OCEAN SPRINGS
MS
05628291
1588004865
LIDDIARD, ROBERT J DPM
OXFORD
MS
06479530
1033293188
LIEN, LILLIAN F MD
JACKSON
MS
08506761
1952716573
LIEU, SANDY N MD
ACKERMAN
MS
05979849
1699087627
LIGHTSEY, LINDA CNNP
GULFPORT
MS
01051083
1487035366
LILES, ANTOINETTE R DMD
LAUREL
MS
02987334
1093912479
LILLEY, JESSICA S MD
TUPELO
MS
06681838
1528475217
LILLEY, YOSHIE S FNP-C
ACKERMAN
MS
07888291
1598086951
LIMANSKY, JOHN M MD
JACKSON
MS
180
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01838356
1730139775
LIMAYLLA, LUCY M MD
GREENVILLE
MS
00118294
1528172244
LIN, ANDREW C MD
HATTIESBURG
MS
00113816
1679652408
LINDER, EDWIN L MD
BATESVILLE
MS
07150886
1295708295
LINDSEY, JASON C DO
HATTIESBURG
MS
06229245
1730217381
LINDSEY, LETICIA A MD
OLIVE BRANCH
MS
05128097
1578589578
LINDSEY, LINDA M.D.
AMORY
MS
09677843
1508208992
LINDSEY, MARY E DO
JACKSON
MS
01673369
1598736605
LINDSEY, MELANIE M
HATTIESBURG
MS
00125782
1669484515
LINDSEY, REESE DO
CLEVELAND
MS
00015799
1225142458
LINDSTROM, ERIC E MD
LAUREL
MS
00114800
1427087592
LINE, JR., LAWRENCE L M.D.
HATTIESBURG
MS
00120646
1073695706
LINEAWEAVER, WILLIAM C MD
JACKSON
MS
00126629
1124020912
LINETT, LAWRENCE M MD
WAYNESBORO
MS
08408709
1043257942
LININGER, KAREN A ACNP
LAUREL
MS
04436306
1346338035
LINTON, MARION C FNP
MERIDIAN
MS
00016479
1124111695
LINTON, RUSSELL C MD
COLUMBUS
MS
07989254
1609981810
LIPE, SHELBY H APRN
LEXINGTON
MS
00126957
1376572123
LIPPINCOTT, CHARLES K MD
TUPELO
MS
02974702
1750416905
LIPPINCOTT, LISA T NP
TUPELO
MS
01053781
1093165805
LIPSCOMB, MARY L NP
TUPELO
MS
03703763
1437499084
LIPSCOMB, MICHAEL PA
SOUTHAVEN
MS
03478773
1164536512
LIPSMEYER, CHRISTOPHER P MD FA
JACKSON
MS
04851330
1225322712
LISENBEE, NATHANIEL P MD
GULFPORT
MS
06689590
1740500214
LITTERER, RACHEL E FNP
ROBINSONVILLE
MS
08282848
1609228642
LITTLE, CANDYCE G NP
TUPELO
MS
00016690
1821184136
LITTLE, NELSON K MD
TUPELO
MS
03428792
1578019808
LITTLE, REBECCA NP
RALEIGH
MS
09030843
1205237377
LITTLE, REBECCA G MSN
JACKSON
MS
181
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00660407
1790855666
LITTLE, REUBEN R DDS
MERIDIAN
MS
06651367
1689792640
LITTLEJOHN, ROBERT L DMD
GREENWOOD
MS
05376274
1306208723
LITTRELL, MARY E MD
JACKSON
MS
07051371
1437267119
LIVELY, BRENDA H CFNP
BILOXI
MS
00011023
1427156108
LIVERMAN, STEVEN B
WESSON
MS
01878766
1467864207
LIVINGSTON, DONALD C MD
JACKSON
MS
06521577
1568874303
LIVINGSTON, ERIN N MD
JACKSON
MS
00660308
1154531754
LIVINGSTON, HAROLD M
JACKSON
MS
00118723
1073532792
LIVINGSTON, MICHAEL C MD
JACKSON
MS
08057018
1134164916
LLOYD, HEATHER D CNP
LELAND
MS
04820586
1770678567
LLOYD, KATHLEEN A FNP
SOUTHAVEN
MS
09335811
1225272602
LLOYD, WANDA L
MERIDIAN
MS
05382334
1932424595
LO, VIVIAN DO
NEW ALBANY
MS
01770751
1942527981
LOBRANO, SUSAN MD
BILOXI
MS
00064701
1679668768
LOBRANO, THOMAS E DDS
CENTREVILLE
MS
00123484
1477560928
LOBRANO, WILLIAM B MD
OCEAN SPRINGS
MS
00015761
1386759835
LOBRONO, CHARLES M MD
GULFPORT
MS
00116489
1063499002
LOCK, JAMES W MD
WALNUT GROVE
MS
00115190
1992886725
LOCKE, WILLIAM R MD
STARKVILLE
MS
05282216
1992786032
LOCKHART, CINDY FNP
MISS STATE
MS
00660245
1215037445
LOCKHART, TAMMI T DMD
STARKVILLE
MS
06136312
1457641276
LOCKLEY, BRANDI R FNP
HATTIESBURG
MS
06524240
1558420067
LOCKWOOD, MATTHEW M MD
CLARKSDALE
MS
00116544
1932155538
LODEN, JULIAN D MD
TUPELO
MS
01001707
1346479235
LODHI, HAMZA A MD
SOUTHAVEN
MS
09024532
1881928315
LOE, KIMBERLY O NP
BRANDON
MS
00118173
1619183605
LOFLIN, BETTY L FNP
FLOWOOD
MS
04729829
1437552155
LOFTIN, MARSHA FNP-C
FLOWOOD
MS
182
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01808562
1609226109
LOFTIN, SHANNON H CNP
COLUMBIA
MS
04787221
1598954125
LOFTISS, CARRIE M MD
TUPELO
MS
00112368
1649573833
LOFTON, SHARON NP
DURANT
MS
01958808
1336572320
LOGAN CARR, KAYLA FNP
JACKSON
MS
00011960
1891832747
LOGAN JR, WILLIAM
CARTHAGE
MS
08607835
1407019375
LOGAN, ANDREA F M.D.
OCEAN SPRINGS
MS
00114365
1376504597
LOGAN, BETTYE NP
COLLINS
MS
08281069
1093079147
LOGAN, CLAIRE S DDS
FULTON
MS
08473501
1801059381
LOGAN, JOHN R MD
PASCAGOULA
MS
05887806
1619124310
LOGAN, QUINISHA K MD
CORINTH
MS
03980080
1558749796
LOGOTHETIS, JILL C NP
PICAYUNE
MS
06087544
1720006489
LOHMEIER, JUSTIN R MD
TUPELO
MS
06378322
1992111462
LOMAX, TERICA R CFNP
WHITFIELD
MS
01333276
1477996965
LONG III, EUGENE M MD
JACKSON
MS
05283311
1598795957
LONG JR, JAMES N MD
CORINTH
MS
00064885
1437332160
LONG SR, ROBERT E DDS
CLARKSDALE
MS
00087903
1932399730
LONG, CONNIE C OD
ABERDEEN
MS
00123788
1861436321
LONG, DENNIS R NP
BILOXI
MS
00987846
1124391347
LONG, DIANA M DDS
VICKSBURG
MS
08951078
1710329156
LONG, JACOB D OD
CHOCTAW
MS
00011981
1689776064
LONG, JOHN H
HAZLEHURST
MS
00059236
1134495484
LONG, KATHERINE PA
JACKSON
MS
08224277
1346535390
LONG, KENNETH M DO
PICAYUNE
MS
00121925
1639383532
LONG, ROBERT C MD
JACKSON
MS
05358859
1043522311
LONG, SCOTT H MD
JACKSON
MS
00115237
1134397961
LONG, VALERIE NP
ABERDEEN
MS
00010518
1851477079
LONGEST JR, TOM B MD
BRUCE
MS
08872277
1205090040
LONGINO, JAMAAL DMD
JACKSON
MS
183
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07180359
1508249830
LONGMIRE, CACHE A FNP-C
FOREST
MS
07722359
1447547930
LONGWITZ, LEAH A NP
LAUREL
MS
08539354
1568807196
LOONEY, ROBERT R DO
MISSISSIPPI STATE
MS
01374059
1013096825
LOOSE, GREGORY D OD
WIGGINS
MS
00122287
1881601409
LOPER, III, WILLIAM E M.D.
RIDGELAND
MS
00011176
1316960867
LOPEZ-SANTINI MD, ROBERTO H
PICAYUNE
MS
08850765
1336544253
LOPRINZI, KRISTINA L NP
TUPELO
MS
00087850
1548301864
LORD JR, WILBURN
ROLLING FORK
MS
09474826
1255472502
LORD, MARY A OD
GREENVILLE
MS
02206742
1487092003
LOREN M ROBINSON ROBINSON FAMILY DE
UNION
MS
00012982
1467541409
LORENZANA, ALICE T
MERIDIAN
MS
03637810
1821352667
LORI JOHNSON
BELZONI
MS
00016031
1760586002
LORIA JR, PHILIP R M.D.
OXFORD
MS
03333061
1265451991
LOTHENORE, MARK A FNP
WALNUT
MS
00115137
1114008950
LOTT JR, CHESTER C MD
STARKVILLE
MS
09785014
1528376894
LOTT, ELIZABETH N CFNP
BELZONI
MS
06773878
1720155427
LOTT, JAMES R DMD
JACKSON
MS
00115249
1548206717
LOTT, JIMMY W MD
JACKSON
MS
00117484
1225079288
LOTT, MARTIN H MD
HATTIESBURG
MS
06184835
1801802913
LOTT, MEGAN R OD
LEXINGTON
MS
01929768
1861809402
LOTT, NICOLE N CNP
HATTIESBURG
MS
00120367
1861417065
LOTT, ROGER T MD
LAUREL
MS
09832569
1386946192
LOTT, SANDRA P FNP
WHITFIELD
MS
01802340
1275789935
LOTT, TIPPINI CFNP
LEXINGTON
MS
04402031
1023070893
LOU, LELAND
MERIDIAN
MS
08838865
1366483075
LOUKATOS, GEORGE M MD
JACKSON
MS
00116099
1689685844
LOUWERENS, JOHN P MD
LELAND
MS
05658543
1558359604
LOVE, BEVERLY R M.D.
NATCHEZ
MS
184
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02088800
1568842334
LOVE, ELIJAH R DMD
CHOCTAW
MS
00118928
1154436574
LOVE, PAMELA NP
HATTIESBURG
MS
01689068
1023228319
LOVE, RANDY S DMD
CANTON
MS
00016630
1598870917
LOVE, SAMUEL K
HATTIESBURG
MS
00120857
1770528713
LOVEJOY, JOHN R MD
HATTIESBURG
MS
00017593
1679504476
LOVELACE, MICHAEL MD
OXFORD
MS
00115056
1306847280
LOVELL, FRANK A MD
GULFPORT
MS
08985812
1164619144
LOVELL, LYDIA E RN
CORINTH
MS
00011956
1215042635
LOVITT, RODNEY N MD
PETAL
MS
00120396
1063445575
LOW, ANNETTE K MD
JACKSON
MS
01502814
1376864249
LOW, DOMINIQUE V MD
JACKSON
MS
01534095
1194104265
LOWE, CATHERINE E MD
JACKSON
MS
00017841
1508860123
LOWE, TERRY R MD
HATTIESBURG
MS
01936776
1013966969
LOWERY, ANGELLE P
OCEAN SPRINGS
MS
00534899
1467471045
LOWERY, JASON D PAC
BILOXI
MS
00426739
1376777201
LOWERY, JENNIFER D MD
RIPLEY
MS
09550025
1396162715
LOWERY, JESSICA S FNP
JACKSON
MS
03572257
1144603325
LOWMAN, GINGER C FNP
TUPELO
MS
00118431
1336184852
LOWREY, PENNI
JACKSON
MS
04231569
1013202019
LOWRY, BRUCE B MD
BAY ST LOUIS
MS
03332243
1285952465
LOWRY, MARY A MD
FLOWOOD
MS
00119201
1619048204
LOWRY, SLATER B M.D.
COLUMBUS
MS
06436745
1275997165
LU, YAN MD
JACKSON
MS
03853367
1689793507
LUBER, KURRE T MD
OXFORD
MS
00118820
1487769808
LUBRITZ, RONALD R MD
HATTIESBURG
MS
08059069
1780970772
LUCAR LLOVERAS, JOSE A MD
JACKSON
MS
00008839
1184997926
LUCAS II, VAN A MD
STARKVILLE
MS
00013434
1093734840
LUCAS III, JOHN F MD
GREENWOOD
MS
185
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00124978
1225060056
LUCAS, AUBREY B MD
FLOWOOD
MS
08487378
1659301109
LUCAS, EDWARD MD
JACKSON
MS
00016520
1639220270
LUCAS, ERIC D
PASCAGOULA
MS
00880146
1588782577
LUCAS, JACQUELYN D
WINONA
MS
00122937
1265452486
LUCAS, MARSHA G MD
GREENWOOD
MS
00124463
1891731055
LUCAS, PHILLIP H MD
PHILADELPHIA
MS
01456367
1053422238
LUCAS, TODD L MD
HATTIESBURG
MS
00015980
1871637157
LUCAS, WILLIE B MD
GREENVILLE
MS
02285260
1457429979
LUCE, THERESE L NP
OXFORD
MS
01001724
1275934580
LUCKEL, GILBERT L CNP
HATTIESBURG
MS
00026834
1194273565
LUCKETT, AMY E NP
JACKSON
MS
00660074
1821104621
LUCKETT, KAREN B DMD
MCCOMB
MS
00117659
1841238557
LUCORE, PETER M MD
GULFPORT
MS
00121109
1194830398
LUCROY, RUBY
MORTON
MS
00117456
1801882147
LUEBRECHT, SHERI W MD
BROOKHAVEN
MS
00016811
1972617140
LUETHJE, RONALD H MD
COLUMBIA
MS
05088733
1407301237
LUMPKIN FREEMAN, STEPHANIE L FNP-C
PICAYUNE
MS
05489321
1538423967
LUNA, MIGUEL A MD
TUPELO
MS
05928545
1275977753
LUND, JEET M DO
JACKSON
MS
02607216
1396085015
LUND, MARION S DPM
OXFORD
MS
09685312
1215146253
LUNDY, ROBERT
JACKSON
MS
07106761
1316942790
LUNSFORD, NOEL CRNP
BROOKHAVEN
MS
08503337
1326421512
LUPENA, ABIGAIL P DMD
PEARL
MS
06380301
1013357276
LUTER, MEGHAN A MD
JACKSON
MS
00115861
1992787907
LUTHER, CYNTHIA H
MERIDIAN
MS
02335571
1194986679
LUTZ, ELIZABETH A MD
JACKSON
MS
02109593
1255628020
LUTZ, JR, JOHN S MD
JACKSON
MS
08482322
1972706927
LUZARDO, GUSTAVO D MD
JACKSON
MS
186
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00119318
1407861776
LYELL, MARK S MD
PASCAGOULA
MS
09928092
1568896165
LYLE, LANA J FNP
STARKVILLE
MS
09209559
1417262890
LYLES, DANA M
GREENVILLE
MS
00117020
1134113095
LYLES, RENEE C FNP
MERIDIAN
MS
04322024
1477818805
LYNCH, GREGORY L MD
JACKSON
MS
01935870
1750705513
LYNCH, STACEY O FPMHN
MERIDIAN
MS
00120400
1386759603
LYNN, CHRISTOPHER S MD
HATTIESBURG
MS
00120432
1134234453
LYNN, JULIE J MD
HATTIESBURG
MS
04235761
1548578719
LYNN, KEICIA T FNP
WEST POINT
MS
00125873
1336208305
LYON, JOHN B MD
LAUREL
MS
00115787
1932201423
LYONS, ALFRED G MD
JACKSON
MS
04884731
1558429522
LYONS, MATTHEW R MD
ROBINSVILLE
MS
01353580
1699719021
LYONS, MICHAEL G DPM
HERNANDO
MS
06457521
1598992794
LYTTLE, MARISSA MD
JACKSON
MS
00119774
1780799981
MAALOUF, MOUSA M.D.
GULFPORT
MS
07920059
1952615692
MABRY, DEANA W CFNP
NATCHEZ
MS
00123004
1447234489
MABRY, MICHAEL S
MS STATE
MS
00013436
1003898859
MABRY, TINA U
LAKE
MS
00404864
1356319941
MACCARONE, KAREN V MD
JACKSON
MS
00018026
1104892363
MACCURDY, DALE M
PICAYUNE
MS
09226703
1013100676
MACDONALD, CARI T NP
PICAYUNE
MS
00118131
1609896976
MACE, THOMAS P MD
GULFPORT
MS
06981006
1578719175
MACHOST, BETHANY M MD
MERIDIAN
MS
03509308
1467406678
MACHRA, GURPREET S MD
SENATOBIA
MS
03886364
1326282427
MACIAS, DAVID M MD
COLUMBUS
MS
03633378
1689040669
MACIAS, GABRIEL L MSN
JACKSON
MS
08681064
1053682781
MACIAS, LEAH A PA
COLUMBUS
MS
03824819
1609131358
MACKEY, DAVID P NP
ECRU
MS
187
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00119546
1699721381
MACKEY, RICHARD L MD
SOUTHAVEN
MS
00123497
1225026032
MACKIE, DEANNA NP
OXFORD
MS
05687341
1265682462
MACMILLAN, MARGARET DO
OXFORD
MS
04904314
1790795276
MADDEN, JOHN B MD
FLOWOOD
MS
00019085
1225256381
MADDOX, BILL F DO
GREENVILLE
MS
07085229
1831319359
MADDUX, ROBERT F MD
GULFPORT
MS
00154789
1750678488
MADEO, JENNIFER L DO
CORINTH
MS
02786032
1366992083
MAFFETT, JESSICA B NP
PONTOTOC
MS
05573530
1801845953
MAGARET, DAVID E MD
CHOCTAW
MS
00660079
1487878054
MAGEE FAMILY DENTAL CARE
MAGEE
MS
00660309
1326244948
MAGEE JR, STEVE DMD
JACKSON
MS
00121028
1033168091
MAGIROS, EVA MD
BILOXI
MS
00113579
1922077452
MAGNUSSEN, CHARLOTTE L
WEST POINT
MS
05308271
1780818542
MAGUIRE, RAYMOND J MD
PASCAGOULA
MS
01130335
1689692972
MAHAFFEY, EARL MD
PRENTISS
MS
00124100
1508824285
MAHAN, LISA J MD
OLIVE BRANCH
MS
02137252
1396033957
MAHARREY, WARREN B DMD
JACKSON
MS
00015369
1407888985
MAHER, BRIAN D MD
GULFPORT
MS
00123593
1760406458
MAHER, JOSEPH F
JACKSON
MS
08170804
1790793081
MAHER, LISA V MD
JACKSON
MS
09350220
1871896571
MAHESHWARI, ANSHU MD
JACKSON
MS
06103221
1114281599
MAHONEY, MEAGAN E MD
JACKSON
MS
02255766
1164716148
MAHOWALD, MICHAEL MD
JACKSON
MS
01031343
1427248970
MAI, MINH Q MD
TUPELO
MS
06777245
1093912370
MAJID, TANWEER H MD
LAUREL
MS
07281714
1316961139
MAJITHIA, DEEPIKA MD
FLOWOOD
MS
00127031
1073540266
MAJITHIA, VIKAS MD
JACKSON
MS
00122678
1356383517
MAJOR JR, JAMES W MD
CLARKSDALE
MS
188
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04129309
1134495526
MAJORS, COREY S MD
JACKSON
MS
08579509
1164886057
MAJORS, LANCE T MD
JACKSON
MS
00207211
1215147350
MAJUMDAR, SUVANKAR MD
JACKSON
MS
09209383
1952450975
MAJURE, JOSEPH M MD
JACKSON
MS
00115781
1528050010
MAKEY, DAVID A MD
MERIDIAN
MS
05189569
1023123353
MAKSI, JOSHUA A MD
HATTIESBURG
MS
09720270
1811359953
MALCOLM, NATHALIE S MD
JACKSON
MS
04307541
1487012043
MALCOM, LACONDRA J PMHNP
LUCEDALE
MS
03907881
1699724294
MALHOTRA, AMIT MD
SOUTHAVEN
MS
04188248
1992050991
MALHOTRA, BHARAT K MD
JACKSON
MS
00117366
1841369907
MALHOTRA, SUNIL MD
SOUTHAVEN
MS
00115234
1659317873
MALLETT, JOHN H MD
BILOXI
MS
00115524
1356564454
MALLETT, PRESLEY D MD
BILOXI
MS
00112990
1467565267
MALLETT, TARA S DO
LUCEDALE
MS
04452210
1740577436
MALLETTE, ANDREW C MD
JACKSON
MS
07039529
1063709327
MALLETTE, KATHRYN H MD
JACKSON
MS
00018493
1205831914
MALLETTE, ROBERT A
JACKSON
MS
06789745
1023314416
MALLEY, JENNIFER L NP
BAY ST LOUIS
MS
00115840
1659353563
MALLOY, DAVID S MD
MERIDIAN
MS
00880064
1306813126
MALONE, WILLIAM E
GULFPORT
MS
03300016
1114134863
MALTBY, KAREN MD
TUPELO
MS
00180721
1689817041
MANDALAPY, KAMAL KISHORE MD
BILOXI
MS
00122091
1730111063
MANEJWALA, FAZAL M M.D.
SOUTHAVEN
MS
09072247
1245644814
MANERO, TABITHA MD
JACKSON
MS
02486090
1164685004
MANGANA, SOPHY H MD
JACKSON
MS
00335839
1447647946
MANGUM, CARL H NP
JACKSON
MS
09280549
1750318143
MANGUM, HEATHER M FNP
SUMMIT
MS
02955264
1821409269
MANGUM-HOLLOMAN, SHANA S MD
JACKSON
MS
189
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00116901
1376564021
MANI-SUNDARAM, DEV A MD
FLOWOOD
MS
03950227
1700073897
MANIMEKALAI, NATESAN MD
JACKSON
MS
07388396
1518307024
MANN, BETSY L FNP
PHILADELPHIA
MS
09037308
1891760351
MANN, JOSHUA R MD
JACKSON
MS
00110589
1922080316
MANN, JR., JOHN E MD
PHILADELPHIA
MS
06180211
1497752760
MANNEY, FANI M MD
OCEAN SPRINGS
MS
00018196
1124061635
MANNING, PATTI MD
COLUMBUS
MS
03772094
1750615076
MANNS, MELANTHA D MD
JACKSON
MS
00115528
1528242724
MANSEL, JOHN K MD
JACKSON
MS
00118990
1326077058
MANSOUR, MICHAEL MD
GREENVILLE
MS
00113615
1306894555
MANSOUR, SAMUEL P MD
BOONEVILLE
MS
00327558
1730223116
MANUCHA, VARSHA MD
JACKSON
MS
04805278
1013921642
MAPLES, DANETT MD
COLUMBUS
MS
03703059
1720333529
MAPLES, JOHN D MD
JACKSON
MS
05438039
1689803603
MAPLES, NATHAN D MD
JACKSON
MS
01029083
1023052669
MAPOSA, DOUGLAS MD
JACKSON
MS
00014762
1871694224
MARANTO, GREG S MD
MERIDIAN
MS
00116642
1649294935
MARASCALCO, DON E
MERIDIAN
MS
03004850
1568571560
MARASCALCO, JOHN A
GRENADA
MS
09121006
1629234463
MARATH, BIJU MD
GULFPORT
MS
08121261
1437192119
MARBLE, BENJAMIN MD
WAYNESBORO
MS
08436261
1396164802
MARBURY, DAVID C MD
JACKSON
MS
08981527
1417343559
MARCELO, DENNIS R MD
JACKSON
MS
00880226
1154365542
MARCEV, DEBORAH J
HATTIESBURG
MS
03951894
1750333555
MARCEV, JOHN R OD
HATTIESBURG
MS
MARCHBANKS, GEORGE A DO
HATTIESBURG
MS
00880199
Jun 11, 2017
09225763
1790180107
MARCHIONNOI, ANTONELLA
JACKSON
MS
08730367
1184815656
MARCUS, JEFFREY MD
GULFPORT
MS
190
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08704531
1861452401
MARCY, MARY A CFNP
NEW ALBANY
MS
00124936
1831141399
MARCY, WILLIAM L MD
BOONEVILLE
MS
06706754
1245613439
MARDINI, JOSEPH-CHARLES DDS
NATCHEZ
MS
06972571
1386055788
MAREK, DAVID D MD
JACKSON
MS
00064760
1033212196
MARIO JOSEPH ROYBAL
BILOXI
MS
08351091
1245529437
MARKLE, DUSTIN L MD
TUPELO
MS
00017129
1104848282
MARKOV, ANGEL MD
JACKSON
MS
00285094
1760613244
MARKS, CHRISTINA G MD
JACKSON
MS
06700750
1841272309
MARKS, DONALD H MD
BILOXI
MS
06682557
1336308287
MARKS, JARED J MD
JACKSON
MS
05886862
1336361989
MARKS, SONYA D MD
TUPELO
MS
04722052
1659533412
MARKS, TYLER G MD
TUPELO
MS
09529306
1356667455
MARLAR, KIMBERLY K NP
CORINTH
MS
00880054
1831181437
MARLER, PHILIP W OD
CARTHAGE
MS
07923550
1104114131
MARLIN, MICHAEL MD
JACKSON
MS
07675091
1235399270
MARLOW, LAUREN W MD
GREENWOOD
MS
00122379
1952344913
MARLOWE, JAMES A
HATTIESBURG
MS
02355729
1619000494
MAROM, ZVI MD
HAZELHURST
MS
09629259
1184784829
MARQUIS, DORIS E DMD
FULTON
MS
00064968
1982764122
MARQUIS, GEORGE DMD
FULTON
MS
00124070
1275586703
MARSALIS, WILTON L MD
MERIDIAN
MS
00724277
1548270721
MARSH, ANDREW R MD
BILOXI
MS
02933071
1699064659
MARSH, JOHN E CRNP
HATTIESBURG
MS
08985581
1770915795
MARSHA E VYVERBERG NP
GULFPORT
MS
00119621
1255475943
MARSHALL, DEREK E
JACKSON
MS
03152381
1609810894
MARSHALL, GAILEN D MD
JACKSON
MS
02622590
1144428749
MARSHALL, LORI H
JACKSON
MS
00119981
1295898724
MARSHALL, NYRON T MD
GULFPORT
MS
191
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02683700
1205048287
MARSHALL, SARAH H FNP
WHITFIELD
MS
09981012
1831176460
MARSHALL, SHIRLEY A MD
COLUMBIA
MS
00702041
1902127152
MARTELLI, MATTHEW G MD
MERIDIAN
MS
04676826
1275869950
MARTIN CHAMBLEE, CRYSTAL L NP
CARTHAGE
MS
00122762
1417993668
MARTIN III, LINUS B
HATTIESBURG
MS
08587356
1356538045
MARTIN, AMANDA L CFNP
MANTACHIE
MS
06780348
1194064188
MARTIN, AMBER N NP
BROOKHAVEN
MS
00115777
1154423499
MARTIN, ANDREW A
VICKSBURG
MS
00124264
1821103185
MARTIN, ARTHUR C
HATTIESBURG
MS
01672508
1619345402
MARTIN, ASHLYNN N FNP
LAUREL
MS
00754004
1013001544
MARTIN, BRADFORD S FNP
FLOWOOD
MS
06974850
1841249489
MARTIN, BRADLEY J PA
MCCOMB
MS
07575621
1932300977
MARTIN, BRYAN B DMD
MAGNOLIA
MS
00122102
1255513230
MARTIN, CARLA A DPM
OLIVE BRANCH
MS
03327346
1285095687
MARTIN, CHELSEA C NP
RIDGELAND
MS
01574265
1063656650
MARTIN, CHRISTOPHER L MD
NATCHEZ
MS
00120808
1912948803
MARTIN, FREDERICK R MD
HATTIESBURG
MS
00115751
1447243472
MARTIN, IRVIN L MD
MERIDIAN
MS
09483510
1124412234
MARTIN, IV, CHARLES C MD
JACKSON
MS
00017758
1427113000
MARTIN, JAMES B MD
OCEAN SPRINGS
MS
08089362
1881986362
MARTIN, JAMES R MD
COLUMBUS
MS
00125758
1831184332
MARTIN, JERRY K MD
OXFORD
MS
00126136
1962566224
MARTIN, JOHN M NP
VANCLEAVE
MS
01138065
1770625048
MARTIN, JOYCE B CFNP
CARRIERE
MS
07152757
1689122277
MARTIN, JULIE K NP
GULFPORT
MS
00122896
1841384443
MARTIN, KELLEY NP
FLORENCE
MS
05583831
1811044613
MARTIN, KENISHA R MD
BROOKHAVEN
MS
00632515
1578516704
MARTIN, LARRY C MD
JACKSON
MS
192
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02126202
1760764690
MARTIN, LORA M NP
MONTICELLO
MS
00113580
1801971908
MARTIN, MURPHY S MD
JACKSON
MS
00118584
1750311874
MARTIN, NANCY S
WHITFIELD
MS
07384221
1023462546
MARTIN, NARJAH M MD
JACKSON
MS
00112817
1679692396
MARTIN, REGINALD W MD
JACKSON
MS
09877072
1891966404
MARTIN, ROBERT A
STARKVILLE
MS
00019858
1336257195
MARTIN, RONALD MD
NEW ALBANY
MS
08571505
1437388055
MARTIN, SCOTT MD
CLINTON
MS
00124809
1548278385
MARTIN, SYLVIA G
SUMRALL
MS
04901563
1679913099
MARTIN, TANDY L CNP
HATTIESBURG
MS
00122593
1902812324
MARTIN, TINA NP
JACKSON
MS
01436898
1245593011
MARTIN, TRESSIE J FNP-B
NEW AUGUSTA
MS
00016353
1215028287
MARTIN, VALENCIA P
GREENWOOD
MS
06250816
1336559327
MARTIN, WILLIAM A
HATTIESBURG
MS
01234014
1447452636
MARTIN, WILLIAM B DMD
BOONEVILLE
MS
00660361
1134289606
MARTIN, WILLIAM C DMD
PHILADELPHIA
MS
00087830
1134226723
MARTINDALE, MARK W
RIPLEY
MS
09152354
1578931655
MARTINEZ, BRITTANY FNP
NEW ALBANY
MS
03633519
1750570198
MARUCCI, CATINA N MD
JACKSON
MS
05900018
1396967519
MARVEGGIO, MARGO R DMD
VICKSBURG
MS
00987362
1093155376
MARYA, ANUJ MD
JACKSON
MS
09025802
1861578635
MASCAGNI, JENNIFER R CFNP
NATCHEZ
MS
09400003
1316142821
MASCIOLI, ANTHONY A MD
SOUTHAVEN
MS
00777811
1063460228
MASIUS, WILLIAM MD
JACKSON
MS
03688762
1992836423
MASK, KELLY S NP
OCEAN SPRINGS
MS
06888741
1285831222
MASON, CHAWLA L MD
JACKSON
MS
06183232
1184074643
MASON, GLENN H NP
STARKVILLE
MS
00119291
1154329860
MASON, HARVEY F
NEW ALBANY
MS
193
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00126264
1104885359
MASON, HELEN H NP
ABERDEEN
MS
07533797
1720090715
MASON, JENEE M NP
JACKSON
MS
00116589
1568486884
MASON, JR, JOHN L
MERIDIAN
MS
09109558
1275731929
MASON, LESLIE F MD
CANTON
MS
09878076
1871944652
MASON, NANCY PMHNP
BRANDON
MS
02284339
1881636645
MASON, PHYLLIS E
TUPELO
MS
02404365
1093172157
MASON, SARAH J PA
BYRAM
MS
00654276
1558776187
MASOODI, HAMMAD M MD
ABERDEEN
MS
07556846
1497109912
MASSENGILL, BRITTANY T MD
JACKSON
MS
00124846
1164537445
MASSEY, BRAD H ACNP
HATTIESBURG
MS
00604803
1346546777
MASSEY, CYNTHIA B FNP
DECATUR
MS
00013293
1649292053
MASSEY, FRED M MD
TUPELO
MS
09385397
1205076809
MASSEY, JENNIFER R CNNP
HATTIESBURG
MS
00125406
1699745133
MASSEY, JONATHAN H
OXFORD
MS
04978011
1154677136
MASSEY, JOSHUA C OD
BAY SPRINGS
MS
06727260
1760723779
MASSEY, KAYLA S FNP
SENATOBIA
MS
08239050
1023429974
MASSEY, KELLY NP
EUPORA
MS
00115812
1336121342
MASSINGILL, SAMUEL S MD
MERIDIAN
MS
00115208
1053358853
MASTERSON, ROBERT C D.O.
VICKSBURG
MS
00018917
1730245739
MATHERNE, PAUL G MD
BILOXI
MS
08678877
1184069825
MATHEW, ANNA J MD
JACKSON
MS
00973826
1629028428
MATHEW, DELLA MD
CHOCTAW
MS
00153898
1760570550
MATHEWS, LEZLIE J NP
GULFPORT
MS
07322877
1093725673
MATHIS, CRAIG A MSN
JACKSON
MS
00121132
1982636676
MATHIS, DAVID M DO
MACON
MS
07003740
1174909865
MATHIS, PRISCILLA M PMHNP
MERIDIAN
MS
00013147
1447230271
MATHIS, ROBERT P MD
CORINTH
MS
07387848
1053622498
MATHIS, TAYLOR P MD
TUPELO
MS
194
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00122352
1760426936
MATTE, DANA W FNP
BROOKHAVEN
MS
00116777
1164417598
MATTHEWS III, JAMES C
MERIDIAN
MS
00115841
1366436925
MATTHEWS JR, JAMES C MD
MERIDIAN
MS
00017429
1760417612
MATTHEWS, ARTHUR M MD
GULFPORT
MS
04177804
1639407331
MATTHEWS, EMILY K DO
MERIDIAN
MS
00115013
1891754057
MATTHEWS, JOHN M
TUPELO
MS
06456342
1043662430
MATTHEWS, SABRINA B NP
GREENWOOD
MS
01735317
1982909453
MATTHEWS, SANDRA A FNP
GULFPORT
MS
09221069
1235403874
MATTHEWS, SARAH K FNP
HATTIESBURG
MS
00017512
1215026208
MATTHIAS, HEDDY D MD
MADISON
MS
06330350
1700254562
MATTINA, JANE NP
BILOXI
MS
01137372
1144580895
MATTOCKS, ERIN N DO
WINONA
MS
01984078
1982828364
MAUCK, BENJAMIN J MD
SOUTHHAVEN
MS
00115503
1902831837
MAULDIN, CHRISTOPHER L MD
LAUREL
MS
00115752
1508917147
MAULDIN, MARK A
PASCAGOULA
MS
01381734
1801229521
MAULDIN, RACHEL NP
TUPELO
MS
04636864
1952719320
MAXWELL, CECILIA M PA
OLIVE BRANCH
MS
00010480
1619911567
MAXWELL, WILBURN M MD
WHITFIELD
MS
00660333
1891852679
MAY JR., GEORGE W M.D.
JACKSON
MS
08708830
1417306218
MAY, ALEXANDER J DMD
MAGEE
MS
01722545
1235532391
MAY, BROOKE N FNPC
SOUTHAVEN
MS
05630363
1629364070
MAY, CHARLES A FNP
LEAKESVILLE
MS
08806035
1831388271
MAY, DAVID C MD
JACKSON
MS
05471776
1457558710
MAY, ELIZABETH H MD
JACKSON
MS
07521546
1073736682
MAY, JUSTIN A DO
OXFORD
MS
00880194
1598758781
MAY, KRISTOPHER A
COLDWATER
MS
07821079
1205278611
MAY, LAUREN A OD
COLDWATER
MS
08886590
1457625493
MAY, LESLIE D MSN
JACKSON
MS
195
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00019333
1356345979
MAY, MICHAEL G MD
JACKSON
MS
06200209
1841536828
MAYERHOFF, SAMANTHA FNP
MERIDIAN
MS
09407724
1275628125
MAYFIELD JR, WALTER G MD
TREMONT
MS
03704346
1285176271
MAYFIELD, AIMEE L FNP-L
PICAYUNE
MS
05378799
1184687972
MAYFIELD, CORNELIUS L MD
GRENADA
MS
07370876
1023110558
MAYFIELD, DALE G DMD
JACKSON
MS
09834040
1497990048
MAYNARD, MIRANDA W OD
PONTOTOC
MS
02601892
1124323555
MAYO, NINA N MSN
JACKSON
MS
00116970
1215931738
MAYO, WILLIAM S DO
OXFORD
MS
00851703
1588813257
MAZUMDER, MANOJ M MD
SOUTHAVEN
MS
00974877
1073733606
MAZURKIEWICZ, MARK R DMD
CORINTH
MS
09185861
1396024949
MBEO, GILBERT O MD
JACKSON
MS
01778834
1598960437
MCADORY, JANE E MD
SOUTHAVEN
MS
03500755
1487858783
MCADORY, RICHARD S MD
TUPELO
MS
05702792
1720082373
MCALEXANDER, WILLIAM P DMD
BYHALIA
MS
06385049
1659779437
MCALLISTER, ANGELA R FNP
JACKSON
MS
08922020
1801090568
MCALLISTER, SUSAN MD
JACKSON
MS
00119631
1881615995
MCALPIN, BRODIE W MD
CORINTH
MS
00122239
1770552259
MCARTHUR III, WILLIAM F MD
LUMBERTON
MS
06027729
1285856468
MCARTHUR, ASHLEY V DMD
LUCEDALE
MS
00114903
1598776338
MCAULEY, JAMES R MD
TUPELO
MS
00119264
1649241878
MCAULEY, ROBERT T
TUPELO
MS
00628875
1710437686
MCBETH, LAPORSHIA A NP
WHITFIELD
MS
01474594
1255426037
MCBRIDE, DOUGLAS P MD
WIGGINS
MS
00087670
1447300629
MCBRIDE, JERRY W OD
FULTON
MS
02726063
1932593548
MCCABE, FULLER W MD
JACKSON
MS
05884351
1326274598
MCCABE, MATTHEW C DDS
GULFPORT
MS
00064965
1063602043
MCCABE, TIM E DDS
GULFPORT
MS
196
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00120621
1063481034
MCCAFFERY, MARY M FNP
BRANDON
MS
05506014
1043685498
MCCAIN, APRIL M NP
TUPELO
MS
02621331
1437542487
MCCAIN, STEPHANIE FNP
EUPORA
MS
08374068
1871694646
MCCALL IV, DANIEL T MD
HATTIESBURG
MS
07780038
1659755676
MCCALLUM, ANGELA FNP
JACKSON
MS
01323301
1689758120
MCCALLUM, DANIEL M MD
NATCHEZ
MS
06135561
1295884617
MCCALLUM, HANNAH E NP
LAUREL
MS
09978266
1710328737
MCCANN, ANDREA M MD
JACKSON
MS
00124633
1497768675
MCCARLEY, CHRISTOPHER K
TUPELO
MS
00556217
1770928707
MCCARLEY, MONICA G NP
TUPELO
MS
05508322
1568421675
MCCARTER, CAREY E FNP
COLUMBUS
MS
01621574
1467650721
MCCARTER, JOHN M MD
HAZLEHURST
MS
00116075
1285663500
MCCARTHY, RICHARD F MD
HATTIESBURG
MS
00060313
1710068739
MCCARTY, JOHN B DMD
MERIDIAN
MS
04389397
1063776532
MCCARTY, JOHN T DO
JACKSON
MS
05553589
1649621368
MCCARTY, KENDRICK NP
BILOXI
MS
09085831
1801058920
MCCARTY, PATRICK MD
GULFPORT
MS
02022531
1487632188
MCCARTY, RICHMOND D
SALTILLO
MS
09854288
1730236605
MCCAUGHAN, DANNY MD
JACKSON
MS
00013222
1487669297
MCCAY, MARVIN B MD
JACKSON
MS
02728341
1912953118
MCCLAIN, FERRELL A MD
BAY SAINT LOUIS
MS
08271560
1891881348
MCCLAIN, JACQUELINE S DDS
CORINTH
MS
00124167
1427163724
MCCLAIN, LACY C
HATTIESBURG
MS
00124695
1962517276
MCCLAIN, MATTHEW D MD
HATTIESBURG
MS
03730025
1609873488
MCCLANAHAN, JAN T MD
COLUMBUS
MS
06225724
1609175579
MCCLANAHAN, MATTHEW MD
BAY ST LOUIS
MS
00124379
1538138250
MCCLELLAN, SHANDRA C
GREENWOOD
MS
08070043
1790735652
MCCLENDON JR, WILLIAM D MD
OCEAN SPRING
MS
197
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04630811
1841566288
MCCLENDON, ERIC E MD
JACKSON
MS
00118938
1659459246
MCCLENTON, THELMA J FNP
STARKVILLE
MS
00060327
1528263159
MCCLINTON DENTAL CLINIC PA
NETTLETON
MS
00060327
1528263159
MCCLINTON DENTAL CLINIC PA
NEW ALBANY
MS
02183861
1386031813
MCCLINTON, PRINCE S NP
JACKSON
MS
04937761
1306215298
MCCLOUD, GREG L NP
RIDGELAND
MS
09501028
1487034849
MCCLOUD, KIMBERLY A CFNP
MONTICELLO
MS
00119499
1144202219
MCCLOUD, MIYAKO
MERIDIAN
MS
01025068
1952588998
MCCLUNEY, RICHARD A MD
TUPELO
MS
00114442
1659314508
MCCLUSKEY, WILLIAM P MD
JACKSON
MS
08309278
1497872253
MCCOLLOUGH, STANLEY F JR
JACKSON
MS
08758585
1043418692
MCCOLLUM III, CHARLES R MD
HATTIESBURG
MS
07154214
1053337139
MCCOLLUM, JAMIE D MD
JACKSON
MS
02009767
1649390782
MCCOLLUM, JOANNA APRN
JACKSON
MS
03832230
1043235047
MCCOMB, WILLIAM D MD
AMORY
MS
03288269
1194179226
MCCORD, ELIZABETH R FNP
SUMMIT
MS
00060212
1306860028
MCCORMICK, ERIC C DMD
BAY SPRINGS
MS
00588206
1992892046
MCCOWAN, NANCYE K MD
JACKSON
MS
08034553
1689765554
MCCOWAN, TIMOTHY C MD
JACKSON
MS
07538291
1326302050
MCCOY BAKER, MANDY M MSN
RIDGELAND
MS
00125854
1851338602
MCCOY, BRIAN D MD
TUPELO
MS
04904532
1043302235
MCCOY, CHERYL R NP
JACKSON
MS
08307530
1992253090
MCCOY, CRYSTAL NP
AMORY
MS
09504023
1700818804
MCCOY, DENNIS D MD
SOUTHAVEN
MS
00126248
1508809062
MCCOY, KEITH E MD
COLUMBUS
MS
00538739
1518417856
MCCOY, KRISTEN C NP-C
FLOWOOD
MS
05559301
1871582981
MCCOY, VICTOR A MD
NATCHEZ
MS
00111822
1679661649
MCCRANEY JR, WARD T MD
FLOWOOD
MS
198
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05523153
1003087289
MCCRANEY, ERIC CFNP
LUCEDALE
MS
09178231
1104878669
MCCRANEY, WILLIAM O MD
FLOWOOD
MS
01823854
1508040551
MCCRARY, ELIZABETH B CFNP
HATTIESBURG
MS
07609227
1245438860
MCCRARY, JEFFREY B MD
FLOWOOD
MS
00114228
1265547301
MCCRARY, RICHARD B MD
GULFPORT
MS
00013011
1679534317
MCCRARY, ROBERT H MD
HATTIESBURG
MS
00636847
1447489919
MCCRARY, SARA JANE D DMD
JACKSON
MS
02739555
1952717274
MCCRORY, BROOK C AGACN
JACKSON
MS
00125739
1710964754
MCCULLOUCH JR, CHARLES L MD
MACON
MS
08873041
1396144549
MCCULLOUGH, AMANDA A NP
JACKSON
MS
00087046
1275526105
MCCULLOUGH, JASPER T OD
BILOXI
MS
01429835
1427451210
MCCULLOUGH, JEN D CFNP
COLUMBUS
MS
00087033
1558542779
MCCULLOUGH, KATHRYN M OD
TUPELO
MS
05833715
1801084744
MCCURDY, WENDY R DDS
HATTIESBURG
MS
04957351
1245544550
MCDANIEL BOLTON, ALLISON MD
PASCAGOULA
MS
00660041
1417048182
MCDANIEL, DAVID
INDIANOLA
MS
09528582
1932280799
MCDANIEL, JACQUELINE FNP
BYHALIA
MS
08174214
1497052211
MCDANIEL, JENNIFER E MSN
JACKSON
MS
04026267
1558670042
MCDANIEL, JESSICA S FNP
DECATUR
MS
01687283
1265868145
MCDANIEL, KASSIA E ACNP
JACKSON
MS
05439871
1831512540
MCDANIEL, SAVANNAH C APRN,
OCEAN SPRINGS
MS
00125627
1013958644
MCDAVID, STEPHEN T DO
PASCAGOULA
MS
05688891
1225226517
MCDERMOTT, ANDREW H PA-C
BILOXI
MS
00122288
1609885342
MCDILL, PHILLIP W M.D.
BRANDON
MS
02129771
1730574187
MCDONALD, ERIC N MD
JACKSON
MS
04433003
1831473552
MCDONALD, JACKIE NP-C
JACKSON
MS
03335287
1295027597
MCDONALD, JAYME R PA-C
JACKSON
MS
01522869
1144532276
MCDONALD, JR, JAY P MD
JACKSON
MS
199
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04277826
1053662007
MCDONALD, KERBY B AMHNP
MERIDIAN
MS
00015128
1285658278
MCDONALD, PHILLIP K MD
MERIDIAN
MS
00089723
1407227549
MCDONALD, ROBIN A NP
TUPELO
MS
08523228
1801015136
MCDONALD, SHARON M MD
JACKSON
MS
05488275
1952795577
MCDONALD, TYLER C MD
JACKSON
MS
00015329
1891897260
MCDONNELL, FRED MD
HAZLEHURST
MS
05352582
1285863886
MCDONNELL, PRESTON B MD
HAZLEHURST
MS
00532864
1528485836
MCDOUGAL, CYNTHIA R NP
GULFPORT
MS
00660457
1033126297
MCDOUGALD, REBECCA S DMD
TUPELO
MS
01153248
1982138533
MCDOWELL, ANGELIA C DNP
CLARKSDALE
MS
02675561
1336699222
MCDOWELL, VALERIE M FNP-C
JACKSON
MS
05423741
1114339082
MCDUFFEY, DENISE L MD
JACKSON
MS
04938212
1114252160
MCDUFFIE, KATHERINE
TUPELO
MS
09278566
1174911960
MCELHANEY, BRITTANY R CFNP
VANCLEAVE
MS
01500371
1538242144
MCELHANEY, SHEENA T PA
HATTIESBURG
MS
07835002
1295081024
MCELROY, TIFFANY L OD
OLIVE BRANCH
MS
05629506
1275714735
MCELVEEN, RUSSELL L DO
JACKSON
MS
03805073
1952698433
MCELWAIN, LUCAS MD
TUPELO
MS
07235716
1972532133
MCELWAIN, SHARON
JACKSON
MS
07003841
1710421490
MCFADDEN, CHRISTINE R FNP
JACKSON
MS
00121943
1386679579
MCFALLS, DEBORAH F NP
CORINTH
MS
04289596
1134437940
MCFARLAND, HILARI D OD
PURVIS
MS
02333389
1841285129
MCFARLAND, THOMAS M MD
MERIDIAN
MS
04375850
1770847154
MCGAUGHEY, RYAN R MD
JACKSON
MS
06739768
1619004744
MCGEE, DARIUS R FNP
LAUREL
MS
00112592
1881675312
MCGEE, HILDA J MD
SUMRALL
MS
00125485
1457345456
MCGEE, ROBERT V M.D.
JACKSON
MS
02202328
1063643476
MCGEE, SUSAN R MD
LAUREL
MS
200
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02124789
1922237965
MCGEHEE, BRANDI S MD
TUPELO
MS
00115715
1619987427
MCGEHEE, DEBBIE P
GRENADA
MS
07283548
1528221207
MCGEHEE, JOSEPH B MD
TUPELO
MS
09471825
1265825962
MCGEHEE, LEAH S FNP
BROOKHAVEN
MS
02479791
1578542007
MCGILBRA, JEFFREY L MD
MERIDIAN
MS
03650568
1962741223
MCGILL, SAMANTHA B NP
OCEAN SPRINGS
MS
03883569
1154495331
MCGILVRA, SUSAN L NP
GREENWOOD
MS
00124665
1083632269
MCGINNIS, PAUL S MD
WHITFIELD
MS
00115995
1184638421
MCGRATH, CYNTHIA M NP
JACKSON
MS
00656791
1689940769
MCGREGER, CANDACE P NPC
NEW ALBANY
MS
00116552
1932110954
MCGUFFEY, ELLEN G
STARKVILLE
MS
00016005
1669460937
MCGUIRE JR, ROBERT A
JACKSON
MS
01074272
1548593817
MCGUIRE, SARAH S NP-C
GULFPORT
MS
04956568
1821036468
MCGUKIN, DONALD R
HORN LAKE
MS
00018132
1053494831
MCHENRY, DAVID G MD
JACKSON
MS
00113820
1649252057
MCHENRY, II, JACKIE E MD
QUITMAN
MS
06277093
1336378819
MCILWAIN, AMBER H MD
WAYNESBORO
MS
03686080
1427239953
MCINNIS, MARK MD
BAY SAINT LOUIS
MS
05522569
1114069465
MCINTEER, BRADEN L DMD
ACKERMAN
MS
02051003
1649243122
MCINTIRE, JR., JOSEPH T
HATTIESBURG
MS
00455774
1801247945
MCINTOSH, ASHLEIGH E FNP-C
CORINTH
MS
00115368
1780791004
MCINTOSH, COOPER A M.D.
OXFORD
MS
09528853
1235571001
MCINTOSH, LEAH M DO
RIPLEY
MS
00930561
1053540617
MCINTOSH, NATHAN MD
HAZLEHURST
MS
00173530
1407067705
MCINTYRE, BENJAMIN C MD
JACKSON
MS
09705832
1114009966
MCINTYRE, JAMES D CFNP
FLOWOOD
MS
00660313
1831271394
MCINTYRE, JOHN N DMD
MENDENHALL
MS
00116088
1801898812
MCIVER, WILLIAM B
COLUMBUS
MS
201
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06033729
1780690545
MCKAY, KARA FNP
SARDIS
MS
00502731
1386844066
MCKAY, KIMBERLY J
MORTON
MS
00115637
1649257858
MCKAY, MICHAEL A MD
GULFPORT
MS
05588277
1063866077
MCKAY, SHOWANDA FNP
SENATOBIA
MS
02029050
1710194071
MCKEAN, GEORGE H MD
BILOXI
MS
08924751
1659711075
MCKEE, JILLIAN M MD
JACKSON
MS
00118447
1972503456
MCKEE, JOHN D MD
OCEAN SPRINGS
MS
05483290
1538190418
MCKELL, LAURI FNP
TUPELO
MS
00016309
1700947579
MCKELLAR, DAVID L MD
HATTIESBURG
MS
07353050
1427416502
MCKENZIE, HANNAH G PA
TUPELO
MS
03638074
1235480880
MCKENZIE, JESICA D NP-C
JACKSON
MS
03824030
1750517660
MCKENZIE, JESSICA A FNP
COLUMBIA
MS
00125062
1265457709
MCKENZIE, LESLIE K MD
JACKSON
MS
05774759
1700190592
MCKENZIE, ROSHUNDIA L FPMHN
MERIDIAN
MS
05158502
1114173267
MCKENZIE, SEEMA A MD
JACKSON
MS
05425811
1255387544
MCKENZIE, TRINITY J MD
HOUSTON
MS
09682813
1316977796
MCKEOWN, JASON L MD
OLIVE BRANCH
MS
00117360
1265589360
MCKETNEY, TERESA L
CANTON
MS
04120735
1386084705
MCKEY, SUSAN E MD
JACKSON
MS
00110394
1093873713
MCKIBBEN, EVERETT C
STARKVILLE
MS
00111934
1174626303
MCKIEVER JR, DANIEL J MD
MERIDIAN
MS
02735526
1164457941
MCKINNEY, DELLIA S OD
JACKSON
MS
05105897
1659330926
MCKINNEY, GERALD MD
JACKSON
MS
00117361
1861485179
MCKINNEY, ROBERT H MD
CORINTH
MS
04908261
1497714786
MCKINNEY, SHAWN A MD
JACKSON
MS
05039704
1275917346
MCKNIGHT, CHELSEA M OD
TUPELO
MS
01921014
1972754034
MCKNIGHT, PATRICIA FNP
TUPELO
MS
06185203
1710347026
MCKNIGHT, SARAH E NP-C
HERNANDO
MS
202
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01439511
1376983791
MCLEAN, JOSEF MD
JACKSON
MS
03371877
1083087076
MCLELLAN, APRIL A NP-C
CARTHAGE
MS
00634762
1902257124
MCLEMORE, ADRIAN NP
BILOXI
MS
07434814
1063709657
MCLEMORE, GERALD R MD
CORNITH
MS
01452240
1780849109
MCLENDON, KILEY S FNP
NEW HEBRON
MS
00116731
1568444024
MCLENDON, LINDA I
MERIDIAN
MS
00110112
1245383033
MCLEOD, CARROLL M MD
JACKSON
MS
07305711
1235493701
MCLEOD, MARY M MD
JACKSON
MS
05238388
1346261864
MCLEOD, MICHELE F FNP-B
HATTIESBURG
MS
09981878
1376698977
MCLEOD, SCOTT H MD
JACKSON
MS
06676328
1801298278
MCLIN, PHAEDRA B FNP-C
HATTIESBURG
MS
00116995
1023196821
MCMAHAN, ELIZABETH D NP
KEMPER
MS
00115828
1669475695
MCMAHAN, LYNN B MD
HATTIESBURG
MS
03632263
1891853420
MCMAHON, WILLIAM MD
JACKSON
MS
00822030
1073812897
MCMASTER, KRISTEN M MD
JACKSON
MS
08277878
1548289010
MCMASTERS, CHARLES E OD
FLOWOOD
MS
07637713
1255420196
MCMICHAEL, REB
WHITFIELD
MS
06039871
1073068003
MCMILLAN BUCHANAN, GINGER D ACNP
TUPELO
MS
01680755
1780086249
MCMILLAN, ABBY M PA
PASCAGOULA
MS
06159350
1821060096
MCMILLAN, JEFFREY B DDS
JACKSON
MS
00117104
1679505853
MCMILLAN, TERRY
GREENWOOD
MS
09775775
1851727689
MCMILLIN, MEREDITH N FNP-C
JACKSON
MS
00116288
1346355583
MCMINN, GLYNNIS D
WIGGINS
MS
06879334
1730141995
MCMINN, JENNIFER FNP
BYHALIA
MS
04923393
1649371816
MCMINN, MISSY J MD
JACKSON
MS
06032264
1033420344
MCMORRIES, RYAN G MD
OXFORD
MS
09605797
1518164490
MCMULLAN, KATHRYN L MD
JACKSON
MS
00119549
1104857036
MCMULLAN, MICHAEL R MD
JACKSON
MS
203
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02573379
1386094704
MCMURPHY, AMANDA T DMD
BILOXI
MS
08703378
1235538075
MCMURPHY, AUSTIN J DMD M
BILOXI
MS
00115281
1720015498
MCMURRAY, ROBERT W
JACKSON
MS
00018123
1700885746
MCNAIR JR, ALFRED E MD
OCEAN SPRINGS
MS
00010311
1851321384
MCNAIR, JR, OBIE M
JACKSON
MS
00012671
1427128255
MCNALLY, EUGENE D MD
GULFPORT
MS
03521862
1558458695
MCNAULL, MELISSA M MD
JACKSON
MS
06905761
1952350001
MCNEAL, LORI L MD
BAY ST LOUIS
MS
02371244
1609185859
MCNEEL, ASHLEY V FNP
TUPELO
MS
01657767
1235220823
MCNEER, MARY E
INDIANOLA
MS
07776850
1659303303
MCNEESE, JASON T MD
FLOWOOD
MS
08121826
1386904803
MCNEESE, STEPHANIE M PMHNP
SOUTHAVEN
MS
00123131
1487672283
MCNEIL, ABBY D CFPMH
MCCOMB
MS
02825807
1285887240
MCNEIL, LORI L NP
JACKSON
MS
05651063
1831453208
MCPHERSON, JOHN R MD
AMORY
MS
06225754
1588037972
MCPHERSON, KRISTEN P FNP-C
MERIDIAN
MS
00011831
1982638292
MCPHERSON, SCOTT H
JACKSON
MS
05734543
1740377399
MCQUARTERS-NORMAN, MARCIA L
MERIDIAN
MS
00660170
1447462817
MCQUEEN, MARVIN E
CORINTH
MS
00016244
1689768434
MCRANEY, THOMAS O
PICAYUNE
MS
06234311
1568446334
MCREYNOLDS, JOHN T MD
COLUMBUS
MS
08907831
1356423404
MCREYNOLDS, WILLIAM R DMD
LOUISVILLE
MS
00118687
1770597163
MCSHAN, MAURICE MD
JACKSON
MS
07580363
1295984748
MCSHURLEY, TIMOTHY D MD
PASCAGOULA
MS
03672877
1174917645
MCVADON, DEANI H MD
JACKSON
MS
00016957
1467433995
MCVEY, III, ERIC A MD
JACKSON
MS
00111378
1669477329
MCVEY, JOHN H
JACKSON
MS
00119312
1124078944
MEACHAM, III, ROBERT R MD
NEW ALBANY
MS
204
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02406090
1609026541
MEACHAM, MELINDA J FNP
KOSCIUSKO
MS
09186513
1376611087
MEADERS, KANISHA L FNP
JACKSON
MS
00125831
1477541514
MEADOR, CHRISTINA L CNP
POPLARVILLE
MS
07279599
1568547750
MEADOR, GORDON H MD
FLOWOOD
MS
01038366
1275732596
MEADOWS, BERNARD J DPM
VANCLEAVE
MS
00122557
1164441994
MEADOWS, RHONDA B NP
JACKSON
MS
00010446
1487866158
MEADOWS, TERRY A DO
MENDENHALL
MS
02182072
1063625325
MECHLEB, BASSAM K MD
LAUREL
MS
02021057
1487841847
MECHLEB, WISSAM K MD
HATTIESBURG
MS
00124465
1417058678
MECK, SHANI K
JACKSON
MS
07624070
1114217189
MEDAURA, JUAN A MD
JACKSON
MS
01378242
1790984813
MEDENWALD STANLEY, ADRIANE L DMD
RIDGELAND
MS
02126562
1497050306
MEDLEY, LINUS S NP
GULFPORT
MS
00014090
1164539599
MEDLIN, JAMES R MD
ACKERMAN
MS
09351824
1952782146
MEECE, MATTHEW A DO
JACKSON
MS
05270308
1942443403
MEECE, TERESA C FNP
GULFPORT
MS
00125972
1881787687
MEEK, EDWIN
GREENWOOD
MS
04924749
1568759199
MEEK, ERIC T MD
MERIDIAN
MS
08474231
1417986910
MEEKIN, GREGORY K MD
GULFPORT
MS
00011109
1063465060
MEEKS II, EDWIN D II MD
COLUMBUS
MS
05303778
1699900159
MEEKS, CHARLES B DO
RIPLEY
MS
09107748
1578586350
MEEKS, JAMES J FNP
OCEAN SPRINGS
MS
00015964
1457375909
MEEKS, WILLIAM M
JACKSON
MS
04478071
1356737985
MEFFERD, JERALD M MD
JACKSON
MS
00934055
1427264647
MEFFORD, AMANDA R MD
SOUTHAVEN
MS
00113705
1154352912
MEGASON, GAIL C MD
JACKSON
MS
01227851
1639117245
MEHRLE JR, ROBERT K MD
JACKSON
MS
03920823
1053576579
MEHTA, AVANI T MD
JACKSON
MS
205
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04035541
1285833608
MEHTA, DIVYANG D MD
JACKSON
MS
00012299
1326139726
MEHTA, MAHESH P MD
JACKSON
MS
08559255
1780768606
MEHTA, NEETA DDS
JACKSON
MS
00011076
1194743138
MEHTA, RUSHIKESH H MD
ELLISVILLE
MS
08628229
1093126757
MEHTA, SHALINI MD
JACKSON
MS
08288249
1558702498
MEHTA, SIDDHANT K MD
JACKSON
MS
00017888
1396778536
MEHTA, USHA J MD
SOUTHAVEN
MS
01059399
1407912223
MEI, SHAWN X MD
GULFPORT
MS
01926759
1225499452
MEILSTRUP, JENNIFER L NP
MCCOMB
MS
03726296
1033249321
MEJIAS SINOPOLI, MELISSA R PAC
OCEAN SPRINGS
MS
00116734
1922037001
MELANCON, KEITH P MD
PICAYUNE
MS
09302506
1821181942
MELGAR, MIGUEL A MD
GULFPORT
MS
07384751
1730108358
MELLEN, PHILLIP B MD
HATTIESBURG
MS
07920551
1538262076
MELOELAIN, JAMIL A MD
MERIDIAN
MS
05078728
1659454650
MELTON, NANCY W FNP
CHOCTAW
MS
00118905
1437239738
MELTON, RAY E NP
BILOXI
MS
06777358
1629103510
MELTON, SANDY D NP
GRENADA
MS
05458719
1770783672
MELTON, SHEREE R MD
JACKSON
MS
08920791
1497718027
MENA, LEANDRO A MD
JACKSON
MS
03976531
1114256260
MENDOZA, SHEON H MD
JACKSON
MS
01537372
1275502403
MENEFEE, DERRECK F MD
TUPELO
MS
00117198
1629008974
MENENDEZ JR, CHARLES V MD
OCEAN SPRINGS
MS
00126490
1083726491
MERCIER, BECKY J CFNP
HATTIESBURG
MS
00096672
1013956325
MEREDITH JR, SAMUEL G MD
RIPLEY
MS
05387807
1114127222
MEREDITH, COURTNEY E MD
BILOXI
MS
00125179
1942248992
MERIDETH, PHILIP T MD
JACKSON
MS
00120028
1235241852
MERLOS, RICARDO M MD
OCEAN SPRINGS
MS
00115630
1376658518
MERRITT, GREGORY
HATTIESBURG
MS
206
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03103231
1275792848
MESSENGER, JULIE M NP C
BILOXI
MS
05982070
1174574701
MESSENGER, KATHLEEN A MD
HATTIESBURG
MS
00018802
1639284888
MESSER JR, THOMAS S MD
HATTIESBURG
MS
05930307
1508906629
MESSER, ALICE F FNP
FLOWOOD
MS
04779888
1023056215
MESSER, CYNTHIA F CNM
MERIDIAN
MS
00014661
1518980887
MESSINA JR, JOSEPH S MD
GRENADA
MS
00116263
1174540066
MESTAYER, ROLAND J
PASCAGOULA
MS
09988811
1770535734
METHVIN, JAMES T DO
STARKVILLE
MS
00116251
1053428060
METIN, NURAY MD
SENATOBIA
MS
00120459
1235102674
METTETAL, CARY N DO
SARDIS
MS
06787540
1194911453
METTETAL, KIMBERLY B
SARDIS
MS
00107010
1851781611
METTS, PAMELA D FNP
LOUISVILLE
MS
03429091
1760627111
MEYER, JESSICA T CFNP
MERIDIAN
MS
00117592
1164436044
MEYER, WILLIAM T M.D.
MERIDIAN
MS
00008822
1083021240
MEYERS, ADAM D CNP
HATTIESBURG
MS
09057366
1932115094
MEYERS, ANNA M
SENATOBIA
MS
02736840
1225241854
MEZA, YENNEY E MD
TUPELO
MS
01988867
1124106133
MICEK, TIMOTHY J MD
SOUTHAVEN
MS
08356704
1831297647
MICHAEL, DANIEL W MD
LAUREL
MS
09107091
1710113634
MICHEL, MICHAEL D MD
TUPELO
MS
00120557
1790734960
MIDDLETON III, ROBERT M
JACKSON
MS
06181398
1922194224
MIDDLETON, ANDREW S
HATTIESBURG
MS
04756033
1366603003
MIDDLETON, PHILIP A DMD
KOSCIUSKO
MS
02272091
1598903577
MIDGETT, ROMERO K MD
MADISON
MS
00452051
1023063955
MIDLER, KAY E DO
FLOWOOD
MS
01473008
1568459345
MIHALKO, MARC J MD
SOUTHAVEN
MS
00125773
1619993367
MIKHAIL, MAGDY G
BILOXI
MS
00014164
1902982077
MILAM, JOHN B MD
JACKSON
MS
207
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01336372
1134159866
MILAM, SHELI D MD
OCEAN SPRINGS
MS
00013284
1992797161
MILAM, WILLIAM H
TUPELO
MS
09883233
1134531130
MILAN, MARIA MD
JACKSON
MS
00279061
1386033298
MILES, AMBER F NP
BAY SPRINGS
MS
00126078
1407887391
MILES, DEREK MD
CLEVELAND
MS
00121255
1295710598
MILES, JANICE L DO
MOSS POINT
MS
00115779
1487677514
MILES, JOHNNY F
TUPELO
MS
09621896
1316987175
MILES, RICHARD J DO
HATTIESBURG
MS
03634394
1750581781
MILES, SONYA M MD
TUPELO
MS
07270056
1962693291
MILEV, DILYANA N MD
HOUSTON
MS
00120600
1689644510
MILEV, TZONKO V MD
TUPELO
MS
07008235
1356364988
MILEY, MATTHEW P DO
JACKSON
MS
06680002
1619205069
MILEY, SALLYE A CPNP
NEWTON
MS
00011396
1841537909
MILHORN, HOWARD T MD
MERIDIAN
MS
00477779
1447690755
MILLER II, JOHN M MD
JACKSON
MS
07221281
1073533196
MILLER III, JULE P
BILOXI
MS
00126246
1285637835
MILLER JR, GEORGE M MD
GRENADA
MS
04187743
1053866681
MILLER, ALISHA L FNP
MERIDIAN
MS
01409375
1609274604
MILLER, AMANDA N NP
GULFPORT
MS
05603817
1265533038
MILLER, AMY C
SALTILLO
MS
00122949
1235215948
MILLER, CAROLD J MD
FLOWOOD
MS
03524309
1780654632
MILLER, CHRISTOPHER D MD
TUPELO
MS
00119953
1578595187
MILLER, DAVID S
JACKSON
MS
06156851
1518361922
MILLER, EDGAR NP-C
JACKSON
MS
00115012
1386603231
MILLER, EDMUND A MD
WEST POINT
MS
03009076
1689089203
MILLER, EDMUND M DO
ABERDEEN
MS
07657751
1588004261
MILLER, JAMES S FNP
JACKSON
MS
02254280
1215310388
MILLER, JEFFREY D NP
RIDGELAND
MS
208
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04123847
1871553370
MILLER, JIMMY D MD
GREENWOOD
MS
00125370
1013983675
MILLER, JOHN H MD
BILOXI
MS
03901053
1588097471
MILLER, KEVIN O NP
TUPELO
MS
00126138
1073548350
MILLER, KIMBERLY W
JACKSON
MS
00126109
1689744278
MILLER, KRISTEN H MD
JACKSON
MS
00037249
1053763813
MILLER, LAKEN B NP-C
LAUREL
MS
06022391
1245527902
MILLER, LAURA J MD
JACKSON
MS
04225328
1730454802
MILLER, MAEGAN A NP
OCEAN SPRING
MS
00018518
1265490718
MILLER, MARK P MD
OLIVE BRANCH
MS
06835533
1477817799
MILLER, MATTHEW A MD
JACKSON
MS
04133561
1992156855
MILLER, MORGAN L
HATTIESBURG
MS
00126491
1821032236
MILLER, PATRICIA A DO
LAUREL
MS
03725590
1376814533
MILLER, PRISCILLA S FNP
MERIDIAN
MS
02022881
1053533406
MILLER, RICHARD E MD
BROOKHAVEN
MS
05579539
1245571124
MILLER, RONALD B FNP
JACKSON
MS
00826075
1457700734
MILLER, SHELLEY A FNP-C
SOUTHAVEN
MS
02758556
1386796191
MILLER, SPENCER O MD
TUPELO
MS
00120504
1740249515
MILLER, TERRY
TUPELO
MS
00124288
1083658702
MILLER, THOMAS A
HATTIESBURG
MS
03133359
1245585082
MILLER, WILLIAM R MD
JACKSON
MS
00016486
1740298967
MILLETTE, TERRY J
PASCAGOULA
MS
00016711
1174591036
MILLETTE, THEODORE M MD
PASCAGOULA
MS
02889735
1578949913
MILLS, EMILEY E NP
CARRIERE
MS
04005234
1376820696
MILLS, KIM NP
GULFPORT
MS
00959361
1881005858
MILLS, MEGHAN D NP
TUPELO
MS
00010581
1649232117
MILLS, REGINA MD
BILOXI
MS
01383764
1942307400
MILLS, RENNIE M PA
JACKSON
MS
06527711
1720001621
MILLS, RICHARD T MD
GREENWOOD
MS
209
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00115587
1326153867
MILLS, STEPHEN J
BROOKHAVEN
MS
08787794
1538322011
MILNER, CARTER P MD
JACKSON
MS
00015466
1356496962
MILNER, G. KLINE MD
JACKSON
MS
01787709
1750580254
MILNER, MATTHEW L DMD
JACKSON
MS
00114812
1356339782
MILNER, PAUL B MD
FLOWOOD
MS
00660215
1679627335
MINCY, CATHERINE J DDS
BOONEVILLE
MS
05359854
1184080640
MINGA, JOSHUA L FNP
ECRU
MS
06679856
1073064820
MINGA, KATHLEEN E PA
NEW ALBANY
MS
00172320
1609271576
MINGA, KATY NP
TUPELO
MS
00126149
1740223924
MINK JR, BILLY E MD
JACKSON
MS
09920709
1548690688
MINOR, CHANDRA M DMD
HAZLEHURST
MS
09523575
1588025373
MINOR, MELISSA J PA
JACKSON
MS
00119463
1326082397
MIRE, BLANE A MD
NATCHEZ
MS
08977863
1467670984
MIRZA, MUHAMMAD M MD
SOUTHAVEN
MS
00051815
1285668921
MISHRA, ABHA MD
GULFPORT
MS
00903734
1265819825
MISKEL, JAYCE D MD
JACKSON
MS
00122932
1962507061
MISSAK, MARY S MD
SOUTHAVEN
MS
07101318
1275705436
MISTER, ANGEL M MD
PURVIS
MS
07650714
1528303294
MITCHELL, APRIL L PMHNP
GREENVILLE
MS
02988368
1558756387
MITCHELL, BARBARA K MD
JACKSON
MS
00124327
1962430074
MITCHELL, ELIZABETH W MD
JACKSON
MS
00123919
1861498024
MITCHELL, GREGORY E MD
NEW ALBANY
MS
09776004
1316225055
MITCHELL, HENRY S OD
LAUREL
MS
00122793
1942234232
MITCHELL, JEFF CFNP
SEMINARY
MS
00087058
1508949355
MITCHELL, JOE R OD
PICAYUNE
MS
00114524
1306884663
MITCHELL, JOHN
TUPELO
MS
00660188
1639224231
MITCHELL, JR, JOHN D DMD
ACKERMAN
MS
09285748
1659721736
MITCHELL, KRISTIN L
TUPELO
MS
210
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05101875
1003128125
MITCHELL, LARKIN H MD
GREENVILLE
MS
08058025
1528158433
MITCHELL, MARC E
JACKSON
MS
00013078
1811937154
MITCHELL, MARK C MD
BILOXI
MS
00126313
1780668954
MITCHELL, MARY ELLEN
TUPELO
MS
06902001
1043427834
MITCHELL, MICHAEL B MD
PICAYUNE
MS
03427320
1881823417
MITCHELL, SARAH Q MD
GREENVILLE
MS
00116682
1306806930
MITCHELL, SHARON B MD
BALDWYN
MS
00857379
1134142250
MITCHELL, SHELLIE V MD
OXFORD
MS
08653064
1407309628
MITCHELL, WILLIAM A N00
LAUREL
MS
00606725
1598951279
MITCHELL-SILVER, KIM A MD
PICAYUNE
MS
01634398
1710262746
MITCHENER, REBECCA A FNP
WEST POINT
MS
09538067
1053622142
MITEMA, DONALD G MD
JACKSON
MS
00119607
1265453401
MITIAS, HANNA M MD
NEW ALBANY
MS
07570531
1699978031
MITRA, SRIPARNA MD
JACKSON
MS
01981084
1871978403
MIXON, FRANKIE B CFNP
LUCEDALE
MS
07433836
1013271428
MIZE, ELIZABETH K MD
OXFORD
MS
04875030
1679896575
MIZELL, AMANDA
GULFPORT
MS
04954763
1114280765
MIZERA, KATHRYN M MD
MERIDIAN
MS
03603016
1619154051
MNZAVA, CHRISTY M
MERIDIAN
MS
00010333
1437266384
MOAK, EDWARD S MD
BROOKHAVEN
MS
03925069
1285781153
MOCK MUHAMMAD, BERTHRONE L MD
JACKSON
MS
07506279
1740308121
MOCK, RAYMOND A RN
GREENVILLE
MS
00753295
1710135629
MOFFETT, JEFFREY R FNP
LAUREL
MS
04584751
1972875995
MOFFETT, KATELYN CRNP
MERIDIAN
MS
06188884
1174606289
MOFFETT, SHANNON L NP
JACKSON
MS
04455509
1902116064
MOFFETT, SHELLIE J NP
AMORY
MS
00122704
1033154547
MOFFITT, JENNIFER L
JACKSON
MS
08008801
1790827210
MOGHBELLI, MEISAM H MD
HATTIESBURG
MS
211
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08029037
1346361169
MOHAMAD, ALMOIS A MD
JACKSON
MS
04979841
1699708008
MOHAMED, EMAD H MD
CORINTH
MS
00119777
1437265972
MOHIUDDIN, JAVED MD
BILOXI
MS
00880180
1598847691
MOHR, JOHN H OD
CLINTON
MS
08656791
1891186219
MOLCK, PAMELA M CPNP
SOUTHAVEN
MS
00016049
1720020258
MOLL JR, GEORGE W MD
JACKSON
MS
03275240
1285096396
MOLL, TERESA A MD
JACKSON
MS
03486006
1316480320
MOLNAR, KRISTINA A FNP
LAUREL
MS
00116212
1437189099
MOLPUS, WILLIAM M MD
HATTIESBURG
MS
06078749
1295990133
MOLVI, SARFRAZ M MD
PASCAGOULA
MS
05458767
1073831749
MOMAH, TOBE S MD
JACKSON
MS
00121038
1619900321
MOMAN, ANDREA M MD
MONTICELLO
MS
00014298
1467561233
MONAGHAN, BROOKS V MD
SOUTHAVEN
MS
07851804
1396009783
MONAGHAN, DAVID K MD
TUPELO
MS
06858549
1912161415
MONGA, DIVYA MD
JACKSON
MS
02623513
1437123825
MONICO, CARLA G MD
JACKSON
MS
04775269
1093262610
MONK, KRYSTLE W FNP
DECATUR
MS
00013158
1982706263
MONROE, JAMES M DO
SMITHVILLE
MS
08751806
1912006859
MONROE, LINDA P MD
JACKSON
MS
07158222
1174885461
MONROE, MICHAEL M DMD
TUPELO
MS
00880207
1700862042
MONROE, NICOLE Y OD
COLDWATER
MS
02482207
1164747986
MONROE, STEPHANIE D NP
RIDGELAND
MS
05652541
1306134093
MONTAGUE, LINDSAY J DMD
JACKSON
MS
00110853
1225147135
MONTALVO, JR., RAMIRO A MD
BROOKHAVEN
MS
00063450
1346392636
MONTEITH, HUGH M DDS
SENATOBIA
MS
00124375
1194816652
MONTESI, MICHAEL W MD
CLEVELAND
MS
00660009
1386850733
MONTGOMERY, ANGELA M DMD
WEIR
MS
00015070
1437156197
MONTGOMERY, CHARLES W MD
TUPELO
MS
212
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08889557
1952595399
MONTGOMERY, ERIN B DMD
MADISON
MS
05957798
1932145067
MONTGOMERY, GRETCHEN S MD
NATCHEZ
MS
03707333
1821027368
MONTGOMERY, JOHN DO
WHITFIELD
MS
03779507
1417155896
MONTGOMERY, JOSEPH B MD
CLINTON
MS
08985808
1346621075
MONTGOMERY, LATRENA NP
JACKSON
MS
00114314
1699735159
MONTGOMERY, STEPHEN Q
PONTOTOC
MS
00116067
1447561345
MONTGOMERY, SUSAN L CFNP
MADISON
MS
02909711
1336157502
MONTZ, JOHN R MD
GULFPORT
MS
06584351
1518962711
MONTZ, NANCY C MD
BILOXI
MS
00017434
1346359197
MOODY, DAVID L MD
CARTHAGE
MS
09971703
1700094489
MOODY, LAURA L DMD
JACKSON
MS
04939509
1740563543
MOODY, NATALIE NP
BRANDON
MS
00060069
1992835151
MOODY, TERRY G DMD
GRENADA
MS
08109847
1275897662
MOON, MELISSA D MD
JACKSON
MS
02508247
1205288495
MOONEY, KELLI P FNP
HATTIESBURG
MS
07134582
1134349913
MOONEYHAM, JENNIFER W NP
BRANDON
MS
06335874
1891176947
MOORE II, JOEL A
TUPELO
MS
00120175
1265479471
MOORE JR, JAMES L MD
JACKSON
MS
00116335
1629098587
MOORE JR, PAUL H MD
PASCAGOULA
MS
06157379
1699137794
MOORE, AARON A MD
JACKSON
MS
06772854
1245330133
MOORE, ALAN R MD
JACKSON
MS
00981821
1114289394
MOORE, ALECIA A DMD
CARTHAGE
MS
00660226
1801968714
MOORE, ANDREW F DMD
CORINTH
MS
04456312
1518131754
MOORE, BENJAMIN C MD
HATTIESBURG
MS
06479354
1902257165
MOORE, CANDICE N FNP-C
BROOKHAVEN
MS
00110493
1699795641
MOORE, CHARLES K
JACKSON
MS
04887535
1801058821
MOORE, CHARLES R MD
HATTIESBURG
MS
05302840
1184086274
MOORE, CINDY M MD
JACKSON
MS
213
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00119560
1417976028
MOORE, DANNY D MD
ABERDEEN
MS
00115185
1861412967
MOORE, DAVID MD
HATTIESBURG
MS
00670028
1619995875
MOORE, DAVID B MD
AMORY
MS
01375519
1114138971
MOORE, DAVID M DMD
VICKSBURG
MS
00119995
1285700443
MOORE, DEBORAH B
CORINTH
MS
07822378
1164567996
MOORE, DOROTHY D NP
HATTIESBURG
MS
00111153
1962582585
MOORE, GALE H
GRENADA
MS
00660163
1952574964
MOORE, GWENDOLYN J DMD
GREENVILLE
MS
00125916
1316033574
MOORE, HUGH S MD
YAZOO CITY
MS
00116271
1760561252
MOORE, JAMES B MD
JACKSON
MS
07406050
1205299005
MOORE, JAMES K DO
JACKSON
MS
00087051
1700834728
MOORE, JAMES S OD
MCCOMB
MS
02274715
1144255225
MOORE, JIMMIE A PA
HATTIESBURG
MS
03435769
1588762223
MOORE, JONATHAN H MD
MERIDIAN
MS
08036756
1841645850
MOORE, KARI D FNP-C
MERIDIAN
MS
02674886
1164886107
MOORE, LEIAH E DO
JACKSON
MS
09983875
1942664917
MOORE, LILY M MD
JACKSON
MS
08733865
1932323904
MOORE, LINDSEY E DO
JACKSON
MS
00251867
1962852988
MOORE, LONNIE L NP
MARKS
MS
08352041
1487899084
MOORE, MICHAEL H DDS
BILOXI
MS
02951729
1184173247
MOORE, MICHELLE FNP
COLUMBUS
MS
00087072
1063465482
MOORE, MISTY A
SOUTHAVEN
MS
02533055
1902055197
MOORE, NATALIE FNP
BATESVILLE
MS
05182213
1962679241
MOORE, PAUL M MD
JACKSON
MS
02409536
1134558653
MOORE, REBECCA T CFNP
CANTON
MS
07076009
1669914826
MOORE, RHONDA A AGPCN
PHILADELPHIA
MS
04133520
1841281276
MOORE, ROBERT L MD
JACKSON
MS
04920052
1750622809
MOORE, SARAH V FNPBC
CHARLESTON
MS
214
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04858052
1952676116
MOORE, SHENITTA D MD
GREENWOOD
MS
00880170
1477662138
MOORE, STACIE L
WEST POINT
MS
00660229
1801930532
MOORE, SUSANNE R DMD
BRANDON
MS
00064270
1275532806
MOORE, T DELTON MD
WOODVILLE
MS
02187267
1124491899
MOORE, TANTE F FNP
OXFORD
MS
01651560
1184776809
MOORE, TERRALL N DO
PASCAGOULA
MS
00115748
1184655060
MOORE, THOMAS C MD
VICKSBURG
MS
07351098
1164689071
MOORE, WHITNEY W NP-C
VANCLEAVE
MS
01935068
1932133345
MOORE, WILLIAM F MD
OCEAN SPRINGS
MS
01685009
1407089907
MOORE, WILLIAM W FNP
BILOXI
MS
00112725
1548280464
MOOSA, YUNUS MD
GULFPORT
MS
00012346
1225110372
MORAN, CARL J MD
GULFPORT
MS
08821006
1386883791
MORAN, JESSICA NP
BILOXI
MS
03020021
1912957473
MORAN, MICHAEL MD
MCCOMB
MS
00019906
1447365606
MORAN, OLIVIA D MD
PRENTISS
MS
00477744
1336591882
MORDECAI, AMANDA J NP
COLUMBUS
MS
09284533
1811383425
MORELLA JR, VINCENT A MD
JACKSON
MS
05089861
1972743797
MOREMEN, JACOB R MD
JACKSON
MS
00880076
1548347834
MORENO, ALVARO J
PETAL
MS
03256737
1710249750
MOREY, NOELLE E MD
JACKSON
MS
03785554
1982751848
MORGAN HENDERSON, CARRIE I MD
JACKSON
MS
00235080
1164770442
MORGAN, AMY S DMD
HATTIESBURG
MS
09533511
1770745630
MORGAN, ANDREA M MD
NEWTON
MS
06105763
1710313044
MORGAN, ASHLEY
JACKSON
MS
00114828
1730187345
MORGAN, DAVID B MD
COLUMBUS
MS
00116189
1194723965
MORGAN, DENNIS P MD
OXFORD
MS
00117241
1235165101
MORGAN, EDITH D CFNP
GREENVILLE
MS
04186821
1154628576
MORGAN, HAILEY C CRNP
MOSS POINT
MS
215
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08120361
1144615972
MORGAN, JARRETT R MD
JACKSON
MS
04723758
1811027436
MORGAN, JUSTIN W MD
TUPELO
MS
00121464
1194749150
MORGAN, KERRY D MD
CORINTH
MS
00451554
1295056349
MORGAN, KIMBERLY L PMHNP
GULFPORT
MS
03731501
1497047971
MORGAN, KIMKESHIA S DNP
MERIDIAN
MS
05788218
1487631461
MORGAN, LISA D CFNP
WIGGINS
MS
00112526
1629042957
MORGAN, MARK W MD
BAY SAINT LOUIS
MS
01321241
1699042754
MORGAN, MELISSA CFPN
RIPLEY
MS
00126373
1386716553
MORGAN, MICHAEL M MD
MADISON
MS
00820094
1326460627
MORGAN, PAULA C NP-C
MERIDIAN
MS
00117719
1063463677
MORGAN, SALLY L CNP
TUPELO
MS
02873070
1689846644
MORGAN, SHEILA L NP
MERIDIAN
MS
00126743
1437105194
MORIARITY, JOHN L MD
FLOWOOD
MS
05787589
1366475030
MORIARITY, RISA MD
JACKSON
MS
04700881
1255364337
MORING, JOSEPH R
ELLISVILLE
MS
04223747
1972830750
MORRELL, RUSSELL D DMD
JACKSON
MS
08052729
1750547212
MORRIS JR, MICHAEL W MD
JACKSON
MS
08523237
1548642747
MORRIS, AMY L FNP-C
FLOWOOD
MS
08652248
1114156858
MORRIS, ANDREA N MD
COLUMBUS
MS
05927057
1831644350
MORRIS, ANDREW S ACNP
FLOWOOD
MS
09938706
1972717361
MORRIS, CAROLINE MD
OLIVE
MS
09738012
1477595643
MORRIS, DAVID G MD
HATTIESBURG
MS
00011931
1689613739
MORRIS, FELIX A MD
IUKA
MS
04324857
1104283068
MORRIS, HEATHER G PA
JACKSON
MS
01334277
1275946964
MORRIS, JAMES E CNP
MOUND BAYOU
MS
04059543
1104908532
MORRIS, JAMES J MD
PASCAGOULA
MS
09928719
1821200429
MORRIS, JASON E MD
OLIVE BRANCH
MS
00118193
1790720779
MORRIS, JASON K
CLARKSDALE
MS
216
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118006
1497710685
MORRIS, JEFFREY A MD
HATTIESBURG
MS
04628844
1285098301
MORRIS, JOHN D MD
JACKSON
MS
00014524
1407813736
MORRIS, JOHN T MD
SOUTHAVEN
MS
09123353
1932641255
MORRIS, JORDAN E FNP
JACKSON
MS
04671371
1356731327
MORRIS, JUSTIN L D.C.
SOUTHAVEN
MS
00117649
1376643486
MORRIS, KENNETH R MD
PEARL
MS
07056765
1407847437
MORRIS, MICHAEL MD
MOUND BAYOU
MS
01339813
1619012846
MORRIS, PAULA A CFNP
HATTIESBURG
MS
07773817
1568627784
MORRIS, RACHAEL F MD
JACKSON
MS
03604868
1982732228
MORRIS, ROBERT W MD
JACKSON
MS
06183764
1487918900
MORRIS, SEGER S DO
CORINTH
MS
00124013
1710984539
MORRISON, GERALYNN G MD
HATTIESBURG
MS
00127042
1790731933
MORRISON, MICHAEL B MD
OXFORD
MS
00016340
1700827243
MORRISON, WILLIAM A
HATTIESBURG
MS
00119757
1760485148
MORRISSETTE, CHARLES T MD
HATTIESBURG
MS
00112630
1043213853
MORRISSON, SUE
HICKORY FLAT
MS
08088857
1922181932
MOSBY, GAYLE FNP
MERIDIAN
MS
00486265
1568653095
MOSELEY, CHARLES W NP
MERIDIAN
MS
00771751
1699714279
MOSES, JACQUELINE MD
RIDGELAND
MS
05650842
1063515807
MOSES, JENNIFER S
JACKSON
MS
00019907
1528138666
MOSES, JR., WALTER C MD
GREENWOOD
MS
00013505
1427197052
MOSES, LOUIS J
GREENWOOD
MS
07335084
1255442562
MOSIER, WILLARD W MD FA
CORINTH
MS
09136045
1962682765
MOSLEY, MISTY S MD
IUKA
MS
04085534
1396056784
MOSS, JAMES A MD
JACKSON
MS
05828281
1649286600
MOSS, MARY L
JACKSON
MS
01702830
1962464883
MOSS, REBEKAH A NP
EUPORA
MS
00118697
1790747269
MOTAKHAVERI, GHOLAM R MD
BILOXI
MS
217
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00777571
1174887319
MOTANYA, DAVID M MD
HATTIESBURG
MS
00880222
1417950262
MOTHERHSED, FRED H
TUPELO
MS
09002360
1306212543
MOTIWALA, HAJRA PA
SOUTHAVEN
MS
06270866
1003095381
MOTT, SHANNON R FNP
MERIDIAN
MS
09300503
1780799965
MOUANNES, WASSIM E MD
LAUREL
MS
07121372
1932200151
MOULDER, REBEKAH W MD
RIDGELAND
MS
07131767
1730220070
MOURAD, HATEM MD
COLUMBIA
MS
06202025
1013202563
MOUTON, CYNTHIA R MD
LUCEDALE
MS
02337065
1427458553
MOWDY, MALLORY E FNP
MEADVILLE
MS
01286715
1801876099
MOWERY, JAMES A DMD
BILOXI
MS
06652353
1992774327
MOWZOON, NIMA MD
TUPELO
MS
00087886
1841363629
MOZINGO, RON C OD
HATTIESBURG
MS
07209048
1922359736
MUFTI, OWAIS A MD
CLARKSDALE
MS
00589501
1083920425
MUKHI, NIKHIL MD
LAUREL
MS
00757060
1891006482
MUKKERA, SRIKANTH MD
TUPELO
MS
05380516
1790913010
MULDREW, KENNETH L MD
JACKSON
MS
00115245
1578509501
MULHOLLAND, DAVID H MD
JACKSON
MS
00121029
1114977451
MULLEN II, PAUL E MD
GULFPORT
MS
00122460
1326102807
MULLEN, KAREN Y MD
BILOXI
MS
07127570
1982056198
MULLEN, KELLI W OD
HATTIESBURG
MS
00937235
1265617021
MULLINIKS, HAYLIE L OD
SOUTHAVEN
MS
02239043
1609238351
MULLINS, DANIEL C MD
JACKSON
MS
09807017
1922238278
MULLINS, JONATHAN B MD
GULFPORT
MS
09973502
1265451074
MULLINS, LAURA B
BRANDON
MS
06209822
1528148483
MULLINS, MELINDA J MD
WHITFIELD
MS
01157508
1609036698
MULLINS, STEPHANIE M ACNP
OXFORD
MS
00118843
1487613774
MULLINS, TRACEY D
GREENWOOD
MS
04926344
1578509659
MULVANEY, DAVID J M.D.
ACKERMAN
MS
218
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04633799
1255356044
MULVIHILL, TERESA G
HATTIESBURG
MS
08501727
1053750059
MUNCIE, COLIN B MD
JACKSON
MS
00116202
1316098833
MUNDINGER JR, GERHARD H MD
FLOWOOD
MS
08882818
1497732374
MUNDORF, LUCINDA L MD
JACKSON
MS
05856864
1396006458
MUNDRA, DEEPTHI DDS
BRANDON
MS
07083393
1710362025
MUNDRA, ESWARA K MD
JACKSON
MS
09550215
1528171469
MUNERA-CORDOBA, PEDRO A MD
HATTIESBURG
MS
00121091
1013964782
MUNGAN, NILS K MD
JACKSON
MS
04583764
1356388250
MUNIR, AMAN U MD
CLARKSDALE
MS
00903364
1417356304
MUNN, DANIEL R FNP
MERIDIAN
MS
00521766
1700147790
MUNN, JULES J MD
SOUTHAVEN
MS
08278361
1275945834
MURDOCK, KEITH W MD
JACKSON
MS
00115964
1578643565
MURILLO-SMITH, NORMA E MD
MERIDIAN
MS
00116073
1669400495
MURPHEY, STEVEN M MD
HATTIESBURG
MS
05482595
1215192588
MURPHREE, JASON M MD
CORINTH
MS
00660452
1316066475
MURPHREE, JR, THOMAS B DDS
WAVELAND
MS
00660351
1952420937
MURPHREE, MARTIN M DDS
KILN
MS
09575773
1164898474
MURPHREE, ROBIN M FNP-B
SEMINARY
MS
09922831
1972912897
MURPHY, CHANEL O NP
AMORY
MS
03672390
1659787430
MURPHY, CHRISTOPHER R DO
JACKSON
MS
06402309
1134416779
MURPHY, DANIEL L MD
JACKSON
MS
05650068
1447454210
MURPHY, ERIN H MD
JACKSON
MS
00116515
1194745521
MURPHY, GEORGE T NP
CLARKSDALE
MS
08588312
1649485855
MURPHY, JASON G MD
JACKSON
MS
07034257
1164797114
MURPHY, JOHN E DMD
TUPELO
MS
00117961
1508959040
MURPHY, JOY R
COLUMBUS
MS
03407781
1235250259
MURPHY, REBECCA FNP
CLARKSDALE
MS
00117593
1891894499
MURRAY, BARBARA B MD
GULFPORT
MS
219
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06889531
1972778421
MURRAY, CHERYL
JACKSON
MS
00014022
1346265899
MURRAY, DONALD
FLOWOOD
MS
07286505
1487999819
MURRAY, KRYSTAL NP
COLUMBUS
MS
01758324
1669594974
MURRAY, MARK G MD
MERIDIAN
MS
02183261
1124389366
MURRAY, MATTHEW MD
MOSS POINT
MS
01932317
1679560270
MURRAY, STACEY F MD
OLIVE BRANCH
MS
00608072
1578827739
MURRIEL, TAKITA M MD
MADISON
MS
03924389
1295016400
MURRY, YOLANDA F FNP-C
MOUND BAYOU
MS
06332867
1568637627
MUSA, ABDEEN R MD
JACKSON
MS
00060422
1841274149
MUSE, DWEEN S DMD
MCCOMB
MS
03930377
1891176848
MUSE, HUGH D MD
JACKSON
MS
00660434
1194825299
MUSGRAVE, CLYDE A DMD
OXFORD
MS
00975748
1679723423
MUSGROVE, ANNE C NP
GULFPORT
MS
07455359
1548313133
MUSICK, STANLEY C MD
JACKSON
MS
07973581
1902861156
MUSKWE, TINOFA O MD
BILOXI
MS
01236311
1801001227
MUTTER, LAURA E MD
BAY SAINT LOUIS
MS
00011490
1528041639
MUTZIGER, JOHN C DO
DECATUR
MS
06028793
1730261686
MUZAMMIL, AYESHA MD
SOUTHAVEN
MS
08853552
1063647667
MYATT, NATHAN E DO
MERIDIAN
MS
00115842
1326020173
MYATT, RAY E MD
MERIDIAN
MS
00064897
1205914298
MYERS II, WILLIAM M DMD
MADDEN
MS
06122731
1760447056
MYERS, ALICE H MD
HATTIESBURG
MS
02828024
1013291228
MYERS, BENJAMIN R DMD
KOSCIUSKO
MS
06084099
1104293463
MYERS, BRADLEY M CNP
HATTIESBURG
MS
02588322
1578941100
MYERS, BRANDON S MD
JACKSON
MS
00118847
1780779306
MYERS, CLARA A MD
JACKSON
MS
00660323
1760626022
MYERS, DEWEY F DDS
JACKSON
MS
09139066
1902917206
MYERS, JENNIFER K MD
CLINTON
MS
220
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06057749
1760645246
MYERS, JESSICA L DO
PHILADELPHIA
MS
02809854
1750464343
MYERS, KATHERINE A PA
HATTIESURG
MS
00125550
1003840240
MYERS, MATTHEW M MD
TUPELO
MS
00112521
1386784239
MYERS, MITCHELL MD
JACKSON
MS
00115536
1265566491
MYERS, RICHARD A DPM
NATCHEZ
MS
05331893
1881958288
MYERS, SHANNON J MD
JACKSON
MS
03623229
1497150056
MYERS, STEPHANIE P FNP-C
HATTIESBURG
MS
04004374
1790129021
MYLES, BENITA J MD
SEBASTOPOL
MS
08726363
1821235474
MYRIOUNIS, NIKOLAOS MD
TUPELO
MS
03037321
1619939204
NABOR, DEANNA R MD
TUPELO
MS
00113896
1598847428
NADING, JOHN H
TUPELO
MS
05026733
1184661373
NAEF, ROBERT W MD
JACKSON
MS
00116245
1144394347
NAFIS, FARHAN MD
MADISON
MS
07584863
1548471311
NAGARAJARAO, HARSHA S MD
JACKSON
MS
00779295
1295086643
NAGUIB ABDALLAH, ABIR N MD
JACKSON
MS
01671319
1174878052
NAIL JR, JOHN P OD
COLUMBUS
MS
07780832
1740329689
NAIL, BRENDA A CFNP
KOSCIUSKO
MS
07387024
1215377809
NAIL, HANNAH J OD
COLUMBUS
MS
02479783
1356781769
NAJPAVER, DANIELLE L PA-C
SOUTHAVEN
MS
01881510
1417198490
NAKAMOTO, ANDREW T MD
GULFPORT
MS
01058712
1770033490
NAKAMOTO, CHRISTINA PA
BILOXI
MS
00271762
1003180092
NALL, KRISTA W DMD
POPLARVILLE
MS
00014971
1336212554
NALLURI, KRISHNA R
GULFPORT
MS
00017743
1871773671
NAMIHIRA, YOSHINOBU MD
VICKSBURG
MS
00116402
1629058375
NANCE, RANDALL L
COLLINSVILLE
MS
09757030
1447232863
NANCE, RICHARD A DO
MERIDIAN
MS
02632558
1679838932
NANDI, UTSAV MD
JACKSON
MS
00113089
1932181740
NANNEY, JAMES M MD
MERIDIAN
MS
221
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00060230
1760519664
NAPIER, RAMON M DMD
PETAL
MS
03750807
1447507009
NAQVI, S ALI A MD
LAUREL
MS
01025302
1902187289
NARANG, RADHIKA MD
JACKSON
MS
00119779
1285679068
NARAYANAN, MANOJ MD
SOUTHAVEN
MS
09050249
1700071008
NARMALA, SHRAVAN MD
BILOXI
MS
03500033
1477007763
NARMOUR, CARRIE D NP
GREENWOOD
MS
06328832
1003006602
NASAJPOUR, HOSSEIN J MD
LAUREL
MS
00123446
1447294475
NASH JR, BINFORD T
JACKSON
MS
07387543
1851590871
NASH, CARRIE R DO
BRANDON
MS
04274568
1598921793
NASH, JERRY L FNP
BRANDON
MS
00060299
1609030642
NASH, KENNETH D DDS
VICKSBURG
MS
07928714
1548643380
NASH, RUSHAUNDA L FNP
MERIDIAN
MS
00108871
1598181943
NATH, VIKAS MD
JACKSON
MS
00203779
1801818877
NATION, KELLY E MD
OCEAN SPRING
MS
00124223
1588692834
NATION, TARA M MSN
JACKSON
MS
00121646
1487601050
NATIONS, KELLY MD
VICKSBURG
MS
00113478
1417932690
NATIONS, ROBIN D MD
BROOKHAVEN
MS
00016402
1154316008
NAUSE JR, CHARLES L DO
GREENWOOD
MS
07500577
1871947176
NAWATHE, AMITA D MD
JACKSON
MS
07434517
1720216492
NAYLOR, YAKEYLA MD
HATTIESBURG
MS
09223372
1851692420
NDZENGUE, ALBERT MD
HAZLEHURST
MS
09803005
1629309059
NEAL ROBERTSON, AMBER M
MISSISSIPPI STATE
MS
00060298
1558423764
NEELY, ROBERT J DMD
JACKSON
MS
00121561
1699765818
NEELY, SUSAN J DO
GREENWOOD
MS
00660095
1144230327
NEELY, WILLIAM T DMD
BRANDON
MS
00115124
1841305950
NEESE, LEWIS MD
HATTIESBURG
MS
04132365
1114330180
NEILL JR, JOHN C MD
JACKSON
MS
06172073
1912987819
NEILL, JAMES S MD
JACKSON
MS
222
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03825391
1639255458
NELMS, MICHAEL C CFNP
BROOKHAVEN
MS
08408287
1750694816
NELMS, TRINA L ACNP
CORINTH
MS
00064611
1659427698
NELSON JR, WILLIAM N DDS
YAZOO CITY
MS
06308777
1962864942
NELSON, CAROLYN M MD
JACKSON
MS
00605330
1912285446
NELSON, EDMOND C MD
TUPELO
MS
00019517
1366470056
NELSON, JOHN C MD
HATTIESBURG
MS
07352756
1912080235
NELSON, JOHN J MD
BILOXI
MS
02705270
1699978932
NELSON, KEVIN M DMD
JACKSON
MS
07175291
1124334511
NELSON, KIMBERLY NP
JACKSON
MS
00122476
1548263312
NELSON, KIPER C MD
HATTIESBURG
MS
00115141
1336220276
NELSON, SCOTT E M.D.
CLEVELAND
MS
01806253
1497787741
NELSON, STEPHEN L MD
OCEAN SPRINGS
MS
00121929
1144323387
NELSON, VIRGINIA C DO
MERIDIAN
MS
03022761
1508952904
NENE, RUTA MD
RIPLEY
MS
00205323
1992882138
NERAVETLA, UJWAL R MD
HATTIESBURG
MS
04033218
1396126355
NESBIT, BRADLEY J MD
JACKSON
MS
04821701
1275601015
NETHERLAND, DONALD E MD
MCCOMB
MS
05775791
1154640878
NETHERY, WENDY DPM
CORINTH
MS
03127385
1609004365
NETTLES GILLIAM, CLAIRE E MD
JACKSON
MS
02032359
1982820130
NEUFFER, MARCUS C MD
OCEAN SPRINGS
MS
00118831
1104821123
NEWCOMB, MARTIN M
JACKSON
MS
03402540
1063871838
NEWELL, CHRISTOPHER J PA
TUPELO
MS
00013752
1962495192
NEWELL, JR., SAMUEL D
TUPELO
MS
00121808
1104886837
NEWELL, RONALD B
GREENWOOD
MS
03278005
1427278894
NEWLON, HEATHER R
MCCOMB
MS
00087081
1407957079
NEWMAN JR, CHARLES S
BILOXI
MS
00660398
1831256965
NEWMAN, ANTHONY D
JACKSON
MS
02207004
1922133206
NEWMAN, CIAO Z MD
SOUTHAVEN
MS
223
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02838545
1568673689
NEWMAN, FARRAH D MD
JACKSON
MS
04703568
1295901221
NEWMAN, JUSTIN R MD
OLIVE BRANCH
MS
00259215
1467716837
NEWMAN, LAURA A MD
JACKSON
MS
09877358
1497947717
NEWMAN, SHEENA NP
BAY ST LOUIS
MS
04106554
1427156637
NEWMAN, TROY M MD
JACKSON
MS
03372270
1043752009
NEWMON, DOMECIA MSN F
SOUTHAVEN
MS
05125706
1912901521
NEWSOM, SANDRA M NP
HORN LAKE
MS
08031269
1417256637
NEWSOM, TONYA L NP
SOUTHAVEN
MS
07608218
1487968103
NEWSON, ANTHONY FNP
TUNICA
MS
00831537
1144518515
NEWTON, LAJUANA Y NP
BRANDON
MS
07382051
1215067491
NEWTON, LARESA V CNP
OCEAN SPRINGS
MS
05333246
1205852092
NEWTON, ROBERT D DMD
AMORY
MS
00788568
1679961270
NGUYEN, DUC V NP
BILOXI
MS
03406575
1114291184
NGUYEN, HANG M NP
GULFPORT
MS
09681811
1558681726
NGUYEN, NGHIA D DO
GULFPORT
MS
00117525
1568408250
NGUYEN, PHILLIP T MD
SOUTHAVEN
MS
08339793
1548303241
NGUYEN, PHUONG
CARRIERE
MS
04908036
1275944282
NGUYEN, RAISA D MD
JACKSON
MS
09050864
1639619331
NGUYEN, SHAUNA PA
JACKSON
MS
07035291
1598729980
NGUYEN, TOM L DO
HATTIESBURG
MS
06122352
1104056415
NICHOLS III, JAMES R DO
INDIANOLA
MS
04586221
1295974988
NICHOLS, ANTONE M
OXFORD
MS
04450554
1457549891
NICHOLS, BRANDON W MD
LUCEDALE
MS
08825365
1265696769
NICHOLS, BRANTLEY P DMD
HATTIESBURG
MS
05372791
1659681328
NICHOLS, CRYSTAL CFNP
MANTACHIE
MS
06273354
1689085474
NICHOLS, JONATHAN R DMD
HATTIESBURG
MS
00119701
1881737401
NICHOLS, KIMBERLY P
JACKSON
MS
04489871
1154635159
NICHOLS, MARGARET E DMD
VICKSBURG
MS
224
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00123548
1427189224
NICHOLS, MICHAEL R MD
FLOWOOD
MS
01484281
1487853859
NICHOLS, TODD MD
JACKSON
MS
08855561
1306258330
NICHOLS, WILLIAM P MD
JACKSON
MS
09687351
1134532450
NICHOLSON, AUSTIN C MD
JACKSON
MS
00060351
1962674655
NICHOLSON, JAMES A DDS
HATTIESBURG
MS
03357816
1508802208
NICKELS, COURTNEY FNP
CANTON
MS
07554061
1083844526
NICKELSON, REGINA S FNP
MERIDIAN
MS
05409534
1376785410
NICKERSON, ASHLEY L DO
CORINTH
MS
05931276
1427050822
NICOLETTI, LISA H NP
BAY ST LOUIS
MS
08221030
1720273535
NICOLS, AMANDA G MD
JACKSON
MS
03785329
1750583415
NICOLS, LEE M MD
JACKSON
MS
01003009
1730476144
NIDA, ANDREW M MD
JACKSON
MS
07558709
1366822397
NIDA, SUZANNA E DMD
VICKSBURG
MS
00122342
1164471074
NIEVAS, HUGO MD
GULFPORT
MS
02124870
1245776343
NIGHTENGALE, SISKINE W NP-C
FLOWOOD
MS
02473328
1619219573
NIKITINA, YANA A MD
JACKSON
MS
00121244
1356395974
NIMO, RICARDO A MD
CENTREVILLE
MS
01378726
1265712145
NIMON, LAURIE A NP
JACKSON
MS
06529522
1285837575
NIOLET, PAUL D MD
OCEAN SPRINGS
MS
08059890
1902811300
NIPPER, ELLIOTT B MD
HATTIESBURG
MS
03254864
1407174188
NIX, EMILY D MD
HATTIESBURG
MS
02370956
1154598357
NIX, STACEY NP
LAUREL
MS
06935861
1063872349
NIX, STEPHANIE PA
TUPELO
MS
01682514
1548353683
NIXON JR, LARRY J MD
JACKSON
MS
07723771
1598833253
NIZIGIYE, JEANNE MD
JACKSON
MS
09488791
1386677474
NJOROGE, LUCY APN
OLIVE BRANCH
MS
00652003
1487677340
NNAWUCHI EKENNA, CHIAZO C MD
PASCAGOULA
MS
04235294
1275806564
NOBLE, ANGELA M FNP-C
PASCAGOULA
MS
225
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00114942
1598734808
NOBLE, MELYNDA C MD
GREENWOOD
MS
07000525
1083016372
NOBLES, HOWARD C CNP
HATTIESBURG
MS
00126114
1245340587
NOBLES, JAMES A MD
MCCOMB
MS
03438889
1811127475
NOBLEZA, CHRISTA O MD
JACKSON
MS
00118266
1508884685
NOBLIN, JEFFERY D MD
BILOXI
MS
00117489
1093726887
NOFAL, ASHRAF M MD
GREENVILLE
MS
04187336
1780758706
NOGUCHI, HIROJI MD
WEST POINT
MS
03605010
1992905384
NOHRA, CHRISTY MD
CLINTON
MS
06875865
1194075416
NOLAN, MELISSA R NP
TUPELO
MS
00018662
1629004502
NOLAN, RATHEL L MD
JACKSON
MS
02771215
1538374285
NOOR, RAHAT MD
VICKSBURG
MS
06773255
1124323175
NOPPER, WENDI L MSN
JACKSON
MS
07802313
1679556989
NORA, FRED E MD
HATTIESBURG
MS
07339567
1760456941
NORDNESS, PAUL J MD
BRANDON
MS
01858357
1861898355
NORMAN, DESIREE M NP
GULFPORT
MS
08757209
1013283829
NORMAN, VANESSA AGNP
UNION
MS
07437399
1457631053
NORRIS WHITE, FELICIA L FNP
GREENVILLE
MS
08502861
1225453905
NORRIS, BETH M FNP
OXFORD
MS
06856779
1053511626
NORRIS, DAVID M MD
JACKSON
MS
08539831
1255341947
NORRIS, JEANETTE MD
CLARKSDALE
MS
00660173
1891812731
NORRIS, LEMONT T DDS
VICKSBURG
MS
05158829
1306166970
NORRIS, LINDSEY T MD
FLOWOOD
MS
04031224
1386047116
NORRIS, NICHOLAS L OD
GREENVILLE
MS
00116025
1316986557
NORRIS, VIRGIL L MD
OXFORD
MS
00018445
1851434575
NORTH, DARDEN H
FLOWOOD
MS
05308309
1780690750
NORTHINGTON, DAVID A DO
WIGGINS
MS
00119189
1124060033
NORTON, JOHN W MD
JACKSON
MS
00119434
1881608495
NORTON, MARK W MD
LAUREL
MS
226
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05255096
1598865362
NORTON, SHERIE R NP
CORINTH
MS
00126032
1750301859
NORTON, TIMOTHY W
HATTIESBURG
MS
02706250
1770855173
NORTON, VALERIE D DO
CORINTH
MS
06578016
1083845614
NORWOOD, ALLISON B
ETTA
MS
00124694
1710947593
NORWOOD, ANNE A NP
JACKSON
MS
05539227
1093910705
NORWOOD, GREGORY DO
MOUND BAYOU
MS
01775857
1598123739
NORWOOD, KIMBERLY P PA
TUPELO
MS
05532816
1447469515
NOVAK, CHRISTOPHER E MD
BILOXI
MS
04124855
1003978081
NOVOTNY, SARAH R MD
CANTON
MS
04205894
1275598781
NOWAK, KRISTIE MD
TUPELO
MS
00013044
1114025905
NOWELL, GARY H M.D.
JACKSON
MS
01522027
1194148130
NOWELL, GAVIN W PA-C
JACKSON
MS
00120013
1649215526
NOWICKI, MICHAEL J MD
JACKSON
MS
00119197
1306815907
NOWICKI, STEVEN D
LAUREL
MS
00119928
1306869375
NOYES, ERICA L MD
CORINTH
MS
00119927
1649294042
NOYES, TIMOTHY L MD
CORINTH
MS
01936050
1912206715
NUGENT, HEATH J MD
GULFPORT
MS
00113935
1487705042
NUNENMACHER, STEPHEN J
OCEAN SPRINGS
MS
00014985
1497869978
NUNEZ, GREGORY R MD
COLUMBUS
MS
00120943
1932132669
NUNEZ, ROGER L
LOUSIVILLE
MS
04282001
1336291681
NUNILON, THOMAS U MD
MERIDIAN
MS
05939288
1013167352
NUNNALLY, CHRISTINA K FNP
ASHLAND
MS
03982567
1891027702
NUSCHKE, RACHAEL C NP
BAY ST. LOUIS
MS
02179793
1265720791
NUTT, JOEL D MD
JACKSON
MS
00726312
1205162583
NUTT, KRYSTIN D NPC
JACKSON
MS
05683205
1881615573
NUTTER, KATHRYN L MD
MERIDIAN
MS
08082841
1386901411
NWORAH, ALEXIS MD
JACKSON
MS
07085224
1801860747
O BANNON, SHAWN P DMD
SALTILLO
MS
227
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08533712
1548430697
O BRYAN, TANYA M DMD
BRANDON
MS
05402731
1194765776
O KELLEY HUGHES, PATRICIA R OD
OCEAN SPRINGS
MS
00204518
1386601755
O NEAL, KATHRYN J ARNP
JACKSON
MS
07889040
1447577184
O'BRIEN, BRENNAN T DMD
NATCHEZ
MS
00880166
1306925029
O'BRIEN, MICHAEL E OD
SOUTHAVEN
MS
09173054
1033151824
O'BRYAN, DEBORAH S
JACKSON
MS
03500366
1669879003
O'DANIEL, AMY FNP
TUPELO
MS
00115334
1730178179
O'GORMAN, JOSEPH D
GULFPORT
MS
01576704
1366409005
O'KEEFFE, RICHARD M MD
LAUREL
MS
00116204
1215088364
O'MARA, CHARLES S MD
JACKSON
MS
00121104
1841288057
O'MARA, JAMES W
JACKSON
MS
04831705
1467509331
O'MARA, PATRICK W MD
TUPELO
MS
00111198
1407800048
O'NEAL, ELLIS H MD
GREENVILLE
MS
08686358
1326594482
O'NEAL, ERIN A CNP
HATTIESBURG
MS
07657803
1790229508
O'QUIN, JOHN W NP
LAUREL
MS
03475771
1780876649
O'REAR, JEFFREY R MD
NEW ALBANY
MS
01602071
1265642482
O'SULLIVAN, PATRICK S MD
BILOXI
MS
00016483
1205829330
OAKES, JR., WILLIAM T
TUPELO
MS
05080509
1215167150
OAKES, LUTHER B MD
GREENVILLE
MS
02209701
1174801765
OBEROI, GULSHAN S MD
LAUREL
MS
00115366
1447270665
OBRIEN, JOHN P MD
NATCHEZ
MS
02882216
1689662702
OBRYAN, JENNIFER M MD
SOUTHAVEN
MS
00121633
1033129440
ODEN, GREGORY S MD
JACKSON
MS
09637798
1811977846
ODENDAHL, KEITH W NP
MCCOMB
MS
00116409
1093798266
ODOM, CYNTHIA C
WAYNESBORO
MS
00011845
1073609467
ODOM, PAUL MD
WATER VALLEY
MS
00015694
1093814980
ODOM, TERRY W MD
AMORY
MS
01173387
1861692204
ODOM-FUNCHES, RHONDA M MD
JACKSON
MS
228
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00774762
1760896195
OFFIAH, MAUREEN N MD
JACKSON
MS
02826328
1467680173
OGBONNA, OBIOMA MD
WEST POINT
MS
07383501
1881816619
OGG, WILLIAM G MD
TUPELO
MS
00122554
1750385365
OGLESBEE, SUSAN R
HATTIESBURG
MS
03621785
1831417732
OGRODNIK, JOSEPH S MD
JACKSON
MS
04323208
1184883316
OH, YOUNGHYUN G MD
JACKSON
MS
00117316
1285747089
OHEA, EUGENE K MD
LUCEDALE
MS
00133536
1053607390
OKEOMA OKEZIE-OKEH, NNEKA MD
GREENWOOD
MS
05723298
1629316609
OKOLO, EMMANUEL O MD
JACKSON
MS
03588841
1265631907
OKORIE, IKECHUKWU H MD
HATTIESBURG
MS
02526790
1386939478
OKUN, SHERRY D MD
TUPELO
MS
03680572
1720428147
OKUNADE, ADEYINKA K MD
JACKSON
MS
07276201
1821006644
OLALEYE, SAMUEL O MD
NEWTON
MS
05523045
1679710933
OLIPHANT, KEISHA L NP
NEWTON
MS
05685057
1619111606
OLIVER, BEVERLY E FNP
JACKSON
MS
06358264
1316387327
OLIVER, CHRISTIAN P MD
JACKSON
MS
02875302
1073775466
OLIVER, JOHN A MD
CLARKSDALE
MS
04181250
1699798306
OLIVER, JOSEPH A MD
MERIDIAN
MS
04028854
1568487304
OLIVER, LEMUEL D MD
OXFORD
MS
00118393
1730258831
OLIVER, ROBERT P MD
GRENADA
MS
05583609
1780948216
OLMSTED, BLAKE R MD
JACKSON
MS
03134047
1427349885
OLSEN, JAMIE L PA-C
GULFPORT
MS
05036359
1356705487
OLU-JOSHUA, OLAMIDE B MD
JACKSON
MS
00119520
1316050750
OLUTADE, BABATUNDE O MD
JACKSON
MS
00119586
1902907223
OLUTADE, INI-ABASI J MD
RIDGELAND
MS
08108016
1477677458
OLUWATADE, OLATUNJI J MD
VICKSBURG
MS
09285061
1124218490
OMARA, AMY P CPNP
JACKSON
MS
00126454
1477669380
OMOLARA, KHARI A
NATCHEZ
MS
229
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01772548
1306821723
OMONUWA, SMITH T MD
MERIDIAN
MS
00010767
1134234750
ONEAL, MICHAEL R MD
PURVIS
MS
00118343
1932158664
ONG JR, MANUEL L MD
CARTHAGE
MS
00118476
1144389925
ONGKINGCO, PACIFICO MD
MERIDIAN
MS
00924057
1700198082
ONWUBIKO, CHINWENDU MD
JACKSON
MS
00122267
1902997778
ONWUBIKO, NGOZI O FNP
BAY SPRINGS
MS
09100019
1891775565
ONYEJEKWE, CHIKE MD
COLUMBUS
MS
00660451
1871607812
ORAL & FACIAL SURGERY CENTER
HATTIESBURG
MS
08250764
1720202153
ORAL & MAXILLOFACIAL SURGERY CENTER
MADISON
MS
00125992
1164514915
ORANGE, RICHARD J
BILOXI
MS
00929340
1295099687
ORDEMANN, ALLISON G MD
JACKSON
MS
00060004
1609974757
OREILLY, WILHELMINA F DDS
JACKSON
MS
08805086
1538263058
ORENDER, MICHEAL MD
TUPELO
MS
00125698
1487639373
ORGLER JR, RAYMOND J MD
TUPELO
MS
00125756
1801867940
ORGLER, EMILY C CFNP
TUPELO
MS
05386771
1811096944
ORLEDGE, JEFFREY MD
JACKSON
MS
00151370
1659456762
ORME, KIRBY MD
CLINTON
MS
04051369
1982686515
ORMSETH, ERIC J M.D.
SOUTHAVEN
MS
03558547
1558315408
OROZCO, LEIGH J NP
BOONEVILLE
MS
02102268
1013132406
ORR, WAYNE S MD
JACKSON
MS
00124957
1063430296
ORSBORN, ANGELA J
NEW ALBANY
MS
06177797
1164607701
ORY, ERICA M MD
JACKSON
MS
02825833
1609256486
OSBORN, SHELLY L DMD
OXFORD
MS
06283506
1346548096
OSBORNE, AMANDA L FNP
HATTIESBURG
MS
00115211
1548356983
OSBORNE, CLARENCE M MD
FLOWOOD
MS
01633001
1174775696
OSBORNE, SUSANNE V MD
PICAYINE
MS
04574762
1720477714
OSBOURN, LACEY G NP
GULFPORT
MS
02883867
1437309028
OSEI, FRANK A MD
JACKSON
MS
230
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08289059
1376735654
OSORIO FIQUEROA, RAMON L MD
STARKVILLE
MS
01471725
1902184419
OSORIO FLORES, MARTIN A MD
JACKSON
MS
01721241
1437383718
OSTRANDER, TROY J DO
NEW ALBANY
MS
00125868
1881785210
OSTROVSKY, OLGA MD
JACKSON
MS
03232771
1487731204
OSULLIVAN, JENNIFER D MD
JACKSON
MS
05606851
1467654376
OSWALD, TANYA M MD
FLOWOOD
MS
04971328
1053474577
OSWALT, CHRISTY T MD
TUPELO
MS
07726532
1700977121
OSWALT, KENNETH E
JACKSON
MS
06757002
1154501096
OSWALT, LISA J CFNP
JACKSON
MS
07579853
1679784599
OSWALT, MATTHEW L MD
TUPELO
MS
07251213
1477660975
OSWALT, SANDRA O NP
LOUISVILLE
MS
00126731
1932164456
OTAIGBE, OMOLARA Y MD
HATTIESBURG
MS
00118577
1104977560
OTEY, STEPHEN K MD
AMORY
MS
01782843
1013360957
OTT, DILLON E OD
WIGGINS
MS
07608766
1538503222
OTTO, AUDREY OD
BAY SPRINGS
MS
05033868
1497162846
OTTO, DAVID A OD
TAYLORSVILLE
MS
08036594
1962451757
OTUSESO, ENILOA MD
VICKSBURG
MS
09639019
1558672865
OUIMET, CHRISTOPHER A MD
GULFPORT
MS
09505058
1174980478
OUTLAW, AISHA R FNP
STARKVILLE
MS
06571268
1912136490
OUZTS, CHARLES A MD
JACKSON
MS
00116845
1821104365
OVERMYER, KENT T M.D.
GULFPORT
MS
00660389
1336292473
OVERSTREET, ANGELA N DMD
MAGEE
MS
05873296
1568875151
OVERSTREET, BRIAN W FNP
JACKSON
MS
00660440
1275675332
OVERSTREET, JEFFREY W DMD
MAGEE
MS
00014986
1447350541
OVERSTREET, RAYMOND G MD
COLUMBUS
MS
05739294
1750716692
OVERSTREET, REBEKAH NP
EUPORA
MS
00126235
1598712135
OVERTON III, CLAYTON J MD
GULFPORT
MS
09072211
1578753943
OWEN, JOSEPH S MD
BILOXI
MS
231
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06782723
1073544615
OWEN, ROBERT C MD
HATTIESBURG
MS
00017546
1972587418
OWEN, STANFORD A MD
HATTIESBURG
MS
00114801
1437205994
OWEN, WILLIAM D MD
LAUREL
MS
04630701
1326307463
OWENS, ANGELA S NP-C
FLOWOOD
MS
00016377
1437160512
OWENS, CYNTHIA DO
HATTIESBURG
MS
03157563
1780624304
OWENS, DAVID C
OCEAN SPRINGS
MS
08078778
1750497590
OWENS, GREGORY R
HATTIESBURG
MS
00121969
1609952241
OWENS, JACK D MD
JACKSON
MS
08300267
1174913859
OWENS, JILLIAN NP
GULFPORT
MS
01188743
1669694063
OWENS, MICHELLE Y MD
JACKSON
MS
02459205
1497189856
OWENS, NICHOLE A MSN N
JACKSON
MS
04001036
1770501173
OWENS, WILLIAM E MD
OXFORD
MS
09128215
1225267305
OYEDEPO, BABADELE MD
TUPELO
MS
00605051
1043650187
OYELEYE, MARY O DMD
JACKSON
MS
00011972
1053373662
OZBORN, CHARLES A
EUPORA
MS
09684360
1427099209
OZDURAN, VOLKAN MD
HATTIESBURG
MS
06238271
1861483075
OZON, ROBERT K
GULFPORT
MS
06000714
1134133556
OZUA, EDWIN I MD
CLARKSDALE
MS
09501839
1265622674
PABBATHI, MADHUSUDHAN R
GREENVILLE
MS
05201798
1477744498
PABBATHI, SABITHA R MD
GREENVILLE
MS
06425300
1649480971
PACE HERNDON, GINGER N MD
SUMRALL
MS
01100205
1366853020
PACE, BENJAMIN R MD
JACKSON
MS
00923066
1851463707
PACE, BRANTLEY B MD
MONTICELLO
MS
00880171
1447315254
PACE, J M OD
PEARL
MS
00120765
1851433585
PACE, JAMES M MD
PRENTISS
MS
01886843
1073811717
PACE, LEE R FNP
GULFPORT
MS
00115036
1912946450
PACE, MARY E MD
TUPELO
MS
05181070
1003103516
PACE, REBECCA MD
JACKSON
MS
232
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06701213
1386703171
PACE, ROLANDA T APRN
MERIDIAN
MS
00115133
1003855784
PACE, SIDNEY K MD
TUPELO
MS
00017719
1073586566
PACE, WILLIAM L
HATTIESBURG
MS
07451830
1316921281
PACKIANATHAN, SATYASEELAN MD
JACKSON
MS
00934557
1013451780
PACLEY, KATRICE L FNP
MERIDIAN
MS
06477805
1083601173
PACOS, ANDREW MD
BOONEVILLE MS
MS
02583572
1891126140
PADDU, NAVEEN U MD
TUPELO
MS
07838541
1710236328
PADEN SESSUMS, COURTNEY M NP
OXFORD
MS
08929301
1750677704
PADGETT, BRIAN K NP
COLLINS
MS
05329389
1962616482
PADUDA, KIMBERLY N MD
JACKSON
MS
00121267
1770634966
PAETZ, BRADLEY A
PASCAGOULA
MS
02308570
1891187431
PAETZ, MARGARET F CPNP
OCEAN SPRINGS
MS
05987239
1790909414
PAGE, MICHAEL B PA
NEW ALBANY
MS
09550526
1730295619
PAGE, SHIRLEY C CFNP
HATTIESBURG
MS
03556749
1932553229
PAIGE, ADRIENNE C MD
JACKSON
MS
00660236
1649210477
PAIGE-BROWN, MELANIE M DDS
GLOSTER
MS
03759341
1588976864
PAINE II, CHARLES C MD
JACKSON
MS
01735381
1255642815
PAINE, PHILIP B MD
JACKSON
MS
09123077
1497960264
PAINTER, CHRISTOPHER M DO
HATTIESBURG
MS
00019888
1538196142
PAKRON, FREDERICK J M.D.
GULFPORT
MS
00524381
1114158367
PALABINDALA, VENKATARAMAN MD
JACKSON
MS
00154827
1962649657
PALADICHUK, SCOTT S OD
HATTIESBURG
MS
00850368
1962745737
PALASIEWICZ, RENATA DO
TUPELO
MS
04030219
1255593257
PALLAV, KUMAR MD
JACKSON
MS
01923741
1093768202
PALM, DANIEL B MD
RIPLEY
MS
00116954
1275569097
PALMER, APRIL L MD
JACKSON
MS
03870261
1265824106
PALMER, ASHLEY C PA-C
HATTIESBURG
MS
00113358
1811088115
PALMER, HERMAN T M.D.
TUPELO
MS
233
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05350301
1649602301
PALMER, JENNIFER FNPC
SEBASTOPOL
MS
02406721
1922054477
PALMER, JULIE R DO
TUPELO
MS
09633866
1376934794
PALMER, MCLAURIN P WHNP
GULFPORT
MS
09384568
1225353840
PALMER, NOEL
MERIDIAN
MS
01027230
1285041038
PALMER, RONSHEKA A FNP-C
MOUND BAYOU
MS
09986891
1316338833
PALMER, VENETTA D FNP
TUPELO
MS
05472771
1487986121
PALOMBARO, ALLYSON M CPNP
JACKSON
MS
06609895
1265745459
PAMARTHY, AMALESWARI MD
JACKSON
MS
05436359
1730591983
PAMBIANCHI, DUSTIN L DMD
LEXINGTON
MS
06972550
1811229057
PANDE, LEENA P MD
GULFPORT
MS
00013335
1619953072
PANDE, PURUSHOTTAN V MD
GULFPORT
MS
00121134
1326008913
PANDE, RAVI MD
GREENWOOD
MS
00012524
1538170683
PANDEY, SHANTI MD
FAYETTE
MS
00578850
1730477837
PANDIT, AMITANILKUMAR MD
JACKSON
MS
04523542
1982803524
PANDYA, KHYATI MD
JACKSON
MS
00118627
1952399156
PANDYA-LIPMAN, RASHMI K MD
SOUTHAVEN
MS
09207801
1013105691
PANG, SENG P FNP
MARKS
MS
00115413
1396840922
PANG, VICTOR G
CLARKSDALE
MS
00227840
1548692130
PANG, WALTER L O.D.
CLINTON
MS
03156827
1235183617
PANKEY, BOBBY C OD
CLINTON
MS
09682739
1649473489
PANNEL, RICHARD S DO
PONTOTOC
MS
03574842
1538123393
PANOS, ANTHONY L MD
JACKSON
MS
09153592
1346475332
PANT, NICOLE MD
SOUTHAVEN
MS
08406750
1497724124
PANTON LATOUCHE, SUZETTE ANN D MD
SOUTHAVEN
MS
04524749
1245333483
PAPANIA, JASON C DMD
GULFPORT
MS
03357281
1811359912
PAPIN IV, JOSEPH E MD
JACKSON
MS
00120424
1427166859
PAPIZAN, CHERIE MD
HATTIESBURG
MS
07784792
1518243146
PAPPA, OSCAR A DDS
JACKSON
MS
234
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118396
1558460162
PAPPAS, JOHN F MD
GULFPORT
MS
00530051
1770710915
PARDEN, ALISON M MD
TUPELO
MS
08073754
1578790895
PARDEN, JUSTIN A MD
TUPELO
MS
00114201
1932126083
PAREKH, KAMLESH H MD
SENATOBIA
MS
00016928
1043267719
PARENT, ANDREW D MD
JACKSON
MS
02601201
1205853116
PARHAM, JASON J
JACKSON
MS
04324224
1154766418
PARHAM, JOHNATHON S MD
JACKSON
MS
04670020
1518247600
PARIKH, KEYUR A MD
TUPELO
MS
00123912
1144241910
PARISH, ANGIE D NP
CLEVELAND
MS
09557027
1194136853
PARISH, COREY B MD
JACKSON
MS
00117683
1245348689
PARISH, NANCY W
CARRIERE
MS
06629278
1477540169
PARK, ASHLEY L MD
SOUTHAVEN
MS
06575065
1710181078
PARK, CHRISTOPHER L DO
NEW ALBANY
MS
05656575
1528480035
PARK, STACIE M CNP
HATTIESBURG
MS
00087095
1922162007
PARKER JR, DAVID J OD
YAZOO CITY
MS
02889869
1053724179
PARKER, ADAM M MD
JACKSON
MS
00113500
1215041116
PARKER, BENTON C
JACKSON
MS
03524746
1982092318
PARKER, BRANDY D NP
PASCAGOULA
MS
00019538
1053357749
PARKER, COLETTE C
JACKSON
MS
00880059
1558321729
PARKER, DAVID L DR
OLIVE BRANCH
MS
05909358
1629477690
PARKER, DENNETTA FNP-C
PEARL
MS
00115001
1801835343
PARKER, DONALD R
TUPELO
MS
07988755
1225186349
PARKER, ELLEN E MD
JACKSON
MS
04024382
1780690842
PARKER, GERALD L MD
AMORY
MS
04078379
1255343570
PARKER, GREG G NP
LAUREL
MS
06754203
1073574687
PARKER, GREGORY D CFNP
LONG BEACH
MS
09424204
1265744510
PARKER, JEREMY W DMD
DIBERVILLE
MS
00117790
1912903766
PARKER, KAREN H NP
LAUREL
MS
235
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02684504
1407964844
PARKER, KENNETH S NP
LAUREL
MS
07882067
1578976387
PARKER, LAWSON B DMD
JACKSON
MS
08657850
1831422336
PARKER, LISA M NP-C
HATTIESBURG
MS
08507040
1063898286
PARKER, LISA M NP-C
JACKSON
MS
07672363
1134130453
PARKER, MADELYN M PM H
MERIDIAN
MS
00660093
1447347349
PARKER, MARK H DDS
PURVIS
MS
03684086
1376783324
PARKER, RENITA T DPM
CLINTON
MS
00936273
1164862512
PARKER, SHARAE J MD
JACKSON
MS
08330084
1851482921
PARKER, TANCI C FPMHN
BATESVILLE
MS
00016766
1558479998
PARKMAN, CHARLES J MD
HATTIESBURG
MS
00120581
1629186382
PARKS, CARMEN L CFNP
BOONEVILLE
MS
04006251
1598928079
PARKS, JOHN L MD
JACKSON
MS
03124874
1457507592
PARKS, LAURA P MD
JACKSON
MS
00600734
1437406485
PARKS, TERESA D PMHNP
CORINTH
MS
04434891
1548259245
PARNELL JR, DONALD MD
BATESVILLE
MS
02072228
1558492744
PARNELL, AIMEE S MD
JACKSON
MS
08373807
1184961054
PARNELL, NORMAN M CFNP
LUCEDALE
MS
06630374
1659682284
PARR, ALEXANDER W MD
JACKSON
MS
00004025
1811242357
PARRISH, HILARY M OD
VICKSBURG
MS
08229576
1790830313
PARRISH, WILLIAM D DMD
GAUTIER
MS
03301384
1093745978
PARRY, JOHN P MD
JACKSON
MS
00121815
1124188347
PARRY, WILSON M MD
FLOWOOD
MS
05355208
1568457828
PARSONS, BILLY D MD
CORINTH
MS
08280011
1447529516
PARSONS, JENNA C MSN
JACKSON
MS
00112774
1760415087
PARSONS, MICHELLE E FNP
COLUMBUS
MS
00013578
1821051756
PARSONS, PRENTISS M MD
ACKERMAN
MS
06854021
1043505266
PARTRIDGE, LESLIE A FNP
JACKSON
MS
00112087
1265540603
PARTRIGE, ROBERT K
WIGGINS
MS
236
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00119307
1154346559
PARVIN, GREGORY
HATTIESBURG
MS
00127030
1770531337
PASHA, AZHAR M MD
MERIDIAN
MS
00115238
1700868734
PASHA, RIZWAN
MERIDIAN
MS
00176333
1821275405
PASHA, SIMEEN R MD
JACKSON
MS
00124366
1285653113
PASSARELLI III, WILLIAM O
PASCAGOULA
MS
02486291
1558379263
PASSER, KEVIN M MD
HATTIESBURG
MS
00120875
1548204050
PATCH, JONATHAN F M.D.
JACKSON
MS
09359303
1740592187
PATCHIN, HEATHER WHNP
MERIDIAN
MS
08929700
1134388200
PATEL, AKASH M MD
JACKSON
MS
00119897
1326123423
PATEL, AMI R MD
FLOWOOD
MS
07655507
1316208093
PATEL, AMIT B MD
COLDWATER
MS
00121838
1417149253
PATEL, AMITA N MD
GREENVILLE
MS
02703288
1770973075
PATEL, ASHISHKUMAR D MD
JACKSON
MS
00115809
1255353652
PATEL, BHARAT R
LAUREL
MS
04355238
1871622969
PATEL, CHANDRAKANT P MD
SOUTHAVEN
MS
07032327
1013398213
PATEL, CHARVI N MD
JACKSON
MS
05479825
1689651036
PATEL, DHARMESH S MD
SOUTHAVEN
MS
08484028
1659339125
PATEL, HARESH M MD
EUPORA
MS
00112405
1992818793
PATEL, HARILAL R MD
LUCEDALE
MS
00055853
1053323758
PATEL, INDRAJIT MD
GULFPORT
MS
03635398
1104036656
PATEL, JAIMIN M MD
JACKSON
MS
00016204
1194872572
PATEL, JAISHRI B
LAUREL
MS
09074054
1487858288
PATEL, KIRTI MD
TUPELO
MS
04800223
1760898373
PATEL, KRUTI P DO
WINONA
MS
00112962
1891776530
PATEL, KUNTHAVAI S MD
HOUSTON
MS
00118200
1487659850
PATEL, MANUBHAI S
JACKSON
MS
00139522
1891136784
PATEL, MINAL P MD
JACKSON
MS
01377283
1275761900
PATEL, NEAL N MD
TUPELO
MS
237
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08375235
1073909156
PATEL, NEELAM A MD
JACKSON
MS
03589042
1255752283
PATEL, NEHA K PA
OLIVE BRANCH
MS
07400716
1255596052
PATEL, NETRALI S MD
JACKSON
MS
01353375
1023499076
PATEL, NIKHIL B MD
JACKSON
MS
00122592
1124098603
PATEL, PRAVINCHANDRA P MD
COLDWATER
MS
00121687
1144214925
PATEL, RAJESH G MD
JACKSON
MS
00018874
1992739130
PATEL, RAMESH
JACKSON
MS
06337068
1669728028
PATEL, RIDDHIBEN MD
JACKSON
MS
04776524
1518127620
PATEL, SHAILESH M DO
TUPELO
MS
00112963
1316911837
PATEL, SHAILESH V MD
HOUSTON
MS
04138841
1780859652
PATEL, SIMAL MD
COLUMBIA
MS
05331232
1093731895
PATEL, VIPIN S MD
FLOWOOD
MS
00502288
1548311103
PATINO, GREGORY A MD
PASCAGOULA
MS
07534516
1821095860
PATLOLA, RAGHOTHAM R MD
HATTIESBURG
MS
06903369
1134478662
PATNANA, SRIKRISHNA V MD
OCEAN SPRINGS
MS
02850756
1366877268
PATRICK, CINDY R FNP
MERIDIAN
MS
05189794
1407102288
PATRICK, JOSHUA O.D.
HATTIESBURG
MS
04882233
1679837058
PATRICK, KATHERINE B MD
JACKSON
MS
07008867
1104116193
PATTEN, JASON R MD
BILOXI
MS
02275564
1386003937
PATTERSON, ALLISON C NP
PRENTISS
MS
09101778
1497139877
PATTERSON, ANNA K O.D.
HATTIESBURG
MS
03285523
1487771176
PATTERSON, BRANDY R MD
TUPELO
MS
00060027
1710921135
PATTERSON, JOHN A DDS
JACKSON
MS
00015869
1801824594
PATTERSON, JOSEPH J MD
HATTIESBURG
MS
04539044
1992900955
PATTERSON, KATHERINE F MD
INDIANOLA
MS
07650820
1467854828
PATTERSON, KRISTIE L CNP
JACKSON
MS
00120914
1053354266
PATTERSON, LAURIE
MEADVILLE
MS
00124306
1073545281
PATTERSON, MICHAEL C M.D.
HATTIESBURG
MS
238
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00115814
1881702231
PATTERSON, PATRICIA D CFNP
NEW AUGUSTA
MS
00019471
1336185610
PATTERSON, RUTH W M.D.
JACKSON
MS
07354860
1417043407
PATTERSON, SHANNON P DMD
JACKSON
MS
05178232
1891233300
PATTERSON, SHERI NP
TUPELO
MS
05021719
1437309978
PATTERSON, STACEY S APRN
HERNANDO
MS
00115687
1467551341
PATTERSON, STEVE J MD
JACKSON
MS
00121347
1003835885
PATTERSON, SUSAN B CFNP
JACKSON
MS
07831757
1275629164
PATTI, DANIEL J DMD
BROOKHAVEN
MS
09126379
1457754855
PATTIE, JENNIFER M CNP
HATTIESBURG
MS
00013801
1003914813
PATTON JR, GEORGE E MD
JACKSON
MS
08329596
1043589054
PATTON, BRANDI PA
OXFORD
MS
00019648
1184612996
PATTON, GREGORY O MD
OXFORD
MS
07223267
1659719334
PAUL, TRACY DMD
YAZOO CITY
MS
00012527
1124179791
PAVLOV, JOHN P MD
OCEAN SPRINGS
MS
00014367
1093755795
PAVLOV, PAUL M
BILOXI
MS
01603878
1063844249
PAXTON, BOBBY L CFNP
INDIANOLA
MS
00115150
1760496475
PAYMENT, MICHAEL MD
GULFPORT
MS
04885745
1740630821
PAYNE, ANGELA I
TUPELO
MS
05487763
1619966066
PAYNE, GINA E CFNP
GULFPORT
MS
06987309
1477723252
PAYNE, JASON A MD
PASCAGOULA
MS
00123114
1760451991
PAYNE, JOHN A MD
GREENWOOD
MS
00125908
1730102740
PAYNE, JOHN P MD
JACKSON
MS
06653567
1457579138
PAYNE, JUNE C NP
BRANDON
MS
00017556
1467563916
PAYNE, WILLIAM D MD
MADISON
MS
01954724
1861713844
PAYNE, WILLIAM D MD
JACKSON
MS
07857865
1093908121
PEARCE, JUDY A CFNP
WHITFIELD
MS
09876839
1780025809
PEARSON, BILLY T NP
MONTICELLO
MS
05601571
1740552439
PEARSON, BOBBIE S NP
COLUMBUS
MS
239
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06430512
1689681942
PEARSON, CYNTHIA E FNP
CORINTH
MS
00110748
1922092881
PEARSON, ERIC J M.D.
MERIDIAN
MS
00117637
1366426355
PEARSON, PHILLIP E DO
OKOLONA
MS
09008260
1366836207
PEARSON, REBEKIAH PA
JACKSON
MS
00115138
1841371671
PEARSON, THOMAS H MD
STARKVILLE
MS
03826562
1578746384
PEARSON, WILLIAM S MD
PASCAGOULA
MS
00122130
1932295995
PEAVEY, MICHAEL T
BROOKHAVEN
MS
00111411
1629163043
PEAVIE, CHARLOTTE H CFNP
JACKSON
MS
08608052
1790192482
PEAVY, COLLIER T NP
JACKSON
MS
07750333
1063823094
PEAVY, PATRICK R MD
JACKSON
MS
00113937
1205944659
PECUNIA, RICHARD A MD
HATTIESBURG
MS
04376251
1346681731
PEDEN, RANDALL A NP
JACKSON
MS
05833061
1700240504
PEDIGO, FRANKIE K MD
JACKSON
MS
06333295
1295911865
PEEPLES III, LEE R MD
GULFPORT
MS
00115127
1063503258
PEEPLES, HOLLY H MD
JACKSON
MS
00115668
1659443836
PEEPLES, SAMUEL H MD
JACKSON
MS
00550671
1871844498
PEERY, DAWN C NPC
RULEVILLE
MS
00120582
1730295064
PEERY, MICHAEL L M.D.
CORINTH
MS
08633853
1093167157
PEGG, JAMES M OD
GRENADA
MS
03883340
1033581665
PEGUES, DEMETRICA S FNP
WATER VALLEY
MS
06876298
1073893624
PELEGRIN, TAMMY L NP
OXFORD
MS
04188045
1255600607
PELLERANO GUZMAN, EDWARD J MD
HATTIESBURG
MS
06806558
1770758450
PEMBROKE, KRISTEN R CRNA
OLIVE BRANCH
MS
05359595
1255425989
PENDERGRASS, DESIREE B MD
JACKSON
MS
00115552
1891797825
PENDERGRASS, JOHN L
HATTIESBURG
MS
04005777
1891850632
PENDERGRASS, PETER W MD
JACKSON
MS
01200048
1497147318
PENDLETON, MONIQUE D NP
LEXINGTON
MS
05484839
1518342963
PENDLETON, NICHOLAS L NP
OCEAN SPRINGS
MS
240
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01486272
1487919957
PENDOWSKI, CANDACE N NP
PASCAGOULA
MS
00112089
1912904590
PENICO, JESSE P MD
GULFPORT
MS
00112194
1770690091
PENNINGTON, ROY D MD
MCCOMB
MS
00176836
1386180610
PENNINGTON, SONJA N NP-C
CLARKSDALE
MS
06588343
1942318589
PENNY, AMANDA S MD
JACKSON
MS
01280868
1326370461
PENTON, CARLA D FNP
PICAYUNE
MS
00125174
1801967674
PERES, KENNETH E
LOUISVILLE
MS
04737518
1477841385
PEREZ, AUGUSTUS J MD
JACKSON
MS
01505726
1578970646
PEREZ, DAVID M DMD
FLOWOOD
MS
00124729
1457348153
PEREZ, EDWARD A MD
SOUTHAVEN
MS
00087904
1467588400
PEREZ, JEFFREY J OD
GULFPORT
MS
03976598
1184037038
PEREZ, MARY A MD
JACKSON
MS
09906571
1336502921
PERKINS IV, FRANK N MD
JACKSON
MS
03003882
1487903936
PERKINS, AMY M FNP-C
SOUTHAVEN
MS
07409833
1033152020
PERKINS, CHARLES H DMD
OXFORD
MS
02821019
1700019478
PERKINS, EMILY D FNP
LOUISVILLE
MS
03559373
1336242239
PERKINS, ISSAC MD
JACKSON
MS
06388552
1730300328
PERKINS, JAMES D MD
LAUREL
MS
09601736
1548600968
PERKINS, JESSICA B MD
JACKSON
MS
04054262
1053508622
PERKINS, JESSICA H DDS
NEW ALBANY
MS
05706314
1558751107
PERKINS, KAYLA L NP
HATTIESBURG
MS
00115005
1700849965
PERKINS, LYNDON H MD
TUPELO
MS
02184263
1598130114
PERKINS, MICAELA D AGNPC
OXFORD
MS
02579036
1417101973
PERKINS, PAMELA CFNP
GREENVILLE
MS
05532354
1104180579
PERKINS, RYAN C MD
JACKSON
MS
08788742
1942607130
PERKINS, SARAH H NP
SENATOBIA
MS
00701279
1326399973
PERKINS, SAVANNAH R CFNP
COLUMBUS
MS
02058365
1164579504
PERKINS, TERESA M DMD
JACKSON
MS
241
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08406392
1649470097
PERKINS, TODD H MD
FLOWOOD
MS
00124941
1265534648
PERKINS-HEDGEPETH, MARLANA E NP
LAUREL
MS
05875261
1992748768
PERNES, CALIN MD
HATTIESBURG
MS
03737571
1114157062
PERNIA, MONA G
CORINTH
MS
08478551
1215334800
PERNICIARO, VANESSA L PA
VICKSBURG
MS
00125681
1518959584
PERRIGO, FELESHA D FNP
BOONEVILLE
MS
05830515
1083833917
PERRIGO, TABITHA C NP
CORINTH
MS
07122075
1033157391
PERRINE, TERRY R
TUPELO
MS
00110058
1578704680
PERRY JR, JOHN K MD
COLUMBUS
MS
00120176
1093752297
PERRY JR, KENNETH G MD
JACKSON
MS
07455505
1013181486
PERRY, ASHLEY N NP
GULFPORT
MS
01079534
1306262993
PERRY, FELESHA R NP
FLOWOOD
MS
00436768
1740734680
PERRY, LACY H NP
PONTOTOC
MS
00178235
1689614513
PERRY, PAUL MD
TUPELO
MS
00060292
1336362219
PERRY, ROBERT H DDS
CORINTH
MS
00122971
1659598050
PERRY, RONALD L DO
NEW ALBANY
MS
02589083
1770673683
PERRY, SATIRA MD
RIDGELAND
MS
00115309
1033196977
PERRY, WILLIAM D
WALNUT GROVE
MS
07600064
1538189543
PERSING, BRIAN E MD
OCEAN SPRINGS
MS
09388880
1851527485
PERSON, BRETT J MD
MERIDIAN
MS
09824051
1437253515
PESSONEY, JOHN T MD
GULFPORT
MS
07728748
1548231269
PETER WISNIEWSKI
OKOLONA
MS
00017300
1114912680
PETERS, JAMES G MD
LOUISVILLE
MS
00907561
1215241153
PETERS, POOJA S PA
SOUTHAVEN
MS
01355242
1780021543
PETERS, ROMA B FNP
JACKSON
MS
05333728
1679638621
PETERS, WILLIAM H MD
HATTIESBURG
MS
08053368
1346684925
PETERSEN, DARLENE NP
GULFPORT
MS
01977252
1306826854
PETERSON, ANDREW J DO
BILOXI
MS
242
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01254298
1710115506
PETERSON, LESLIE E CFNP
MANTACHIE
MS
00126574
1295927226
PETRIDES, TRACEY F MD
ROBINSONVILLE
MS
00017867
1487769154
PETRO, ANTHONY B MD
JACKSON
MS
00115554
1124020169
PETRO, JOHN V
HATTIESBURG
MS
04574829
1679561948
PETRO, MICHELLE A MD
FLOWOOD
MS
09902835
1093978918
PETTIE, SHANNA MD
JACKSON
MS
01758833
1679740997
PETTIGREW, NEVA J FNP
MERIDIAN
MS
09782055
1831536333
PETTY, GEORGE L MD
MERIDIAN
MS
07323571
1750755328
PETTY, LESSLEY A FNP
VICKSBURG
MS
00332092
1366760001
PETTY, TIFFANY J MD
MT PLEASANT
MS
02126502
1356323281
PHAM, HIEU MD
OLIVE BRANCH
MS
08670521
1518351626
PHAM, VUONG-IAM H MD
JACKSON
MS
07588298
1083902613
PHAM, YEN H FNP
SOUTHAVEN
MS
04032578
1881859056
PHARES, MATTHEW DO
JACKSON
MS
00126320
1174652945
PHARR, RICHARD W MD
BRANDON
MS
00118410
1194805457
PHELAN, JAMES T DPM
VICKSBURG
MS
00119566
1962538082
PHELAN, STEPHANIE F
MADISON
MS
00113141
1194947754
PHELON, JACQUELINE S FNP
WHITFIELD
MS
00115977
1205932134
PHELPS, BARBARA J NP
VICKSBURG
MS
00064770
1467572206
PHILLEY, JAMES R DMD
GRENADA
MS
00115969
1184610388
PHILLIPPI III, FRANCIS M MD
MERIDIAN
MS
08178047
1578674883
PHILLIPPI, CATHERINE P MD
JACKSON
MS
01729816
1841551496
PHILLIPPI, DINO R MD
JACKSON
MS
05331376
1871678029
PHILLIPPI, FRANCIS M MD
FLOWOOD
MS
03023144
1881714764
PHILLIPS & WHITE ORTHODONTICS P A
GREENWOOD
MS
04486325
1588651954
PHILLIPS III, HARRY V MD
SOUTHAVEN
MS
00016286
1942220637
PHILLIPS III, JOHN H M.D
BILOXI
MS
00116024
1558462382
PHILLIPS, ANDREA L
JACKSON
MS
243
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00882526
1578550976
PHILLIPS, BARRY B MD
SOUTHAVEN
MS
08689796
1306105705
PHILLIPS, BRENDA L NP
MERIDIAN
MS
04225858
1477870822
PHILLIPS, CATHERINE D DO
OXFORD
MS
00825215
1972853125
PHILLIPS, CHRISTOPHER D FNP
PONTOTOC
MS
00010415
1679571491
PHILLIPS, CLYDE B MD
TUPELO
MS
00124933
1396740882
PHILLIPS, DOUGLAS C MD
MERIDIAN
MS
03908796
1376557892
PHILLIPS, EARL MD
GULFPORT
MS
00115950
1366555328
PHILLIPS, EDWARD K
RIDGELAND
MS
01925511
1477714731
PHILLIPS, JANA W MD
JACKSON
MS
00479267
1477833770
PHILLIPS, JANNA T FNP
LAUREL
MS
01903853
1750665063
PHILLIPS, JENNIFER W FNP
PHILADELPHIA
MS
00116829
1023077732
PHILLIPS, JOHN O M.D.
TUPELO
MS
00116691
1366550758
PHILLIPS, JOSEPH MD
HATTIESBURG
MS
03053368
1407955537
PHILLIPS, JOSHUA F MD
JACKSON
MS
07786011
1780927442
PHILLIPS, LADONNA M ANP
LAUREL
MS
03355409
1124367644
PHILLIPS, LAURA L NP
JACKSON
MS
02405855
1538573316
PHILLIPS, LYNSEY G DMD
RULEVILLE
MS
00110336
1821124728
PHILLIPS, MARK T MD
MERIDIAN
MS
07623848
1366723710
PHILLIPS, MATTHEW B
HATTIESBURG
MS
06704215
1881884872
PHILLIPS, MICHAEL J OD
RIDGELAND
MS
00660304
1942366166
PHILLIPS, SCOTT M
JACKSON
MS
05770521
1275763823
PHILLIPS, STUART L MD
JACKSON
MS
01022856
1932463312
PHILLIPS, SUSIE B MD
JACKSON
MS
06027878
1508013293
PHILLIPS, TRACY B OD
MERIDIAN
MS
08520215
1295192151
PHILLIPS-COAKLEY, CARLA NP-C
RIDGELAND
MS
00119397
1902818875
PHIPPS, GAIL
LAUREL
MS
07189871
1467663906
PICARELLA, EMILE A MD
JACKSON
MS
00116715
1487679841
PICKARD, PAUL W MD
LAUREL
MS
244
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00117804
1487762787
PICKERING, BILLY MACK P MD
SEMINARY
MS
00116505
1881610756
PICKERING, LINDA A CFNP
CARTHAGE
MS
01239255
1003951724
PICKERING, TREVOR R MD
JACKSON
MS
09220725
1346629326
PICKERING, WILLIAM B ACNP
HATTIESBURG
MS
09787378
1699138479
PICKETT, JASON C MD
JACKSON
MS
06373201
1649550708
PICKLE, TERESA K CFNP
GRENADA
MS
02551029
1073545554
PICKUS, EVAN J MD
CARTHAGE
MS
00113432
1417970518
PIDIKITI, NANNI MD
CORINTH
MS
00118347
1144209313
PIERCE JR, VOLNEY E MD
JACKSON
MS
00060076
1447304324
PIERCE, CARROLL D DMD
ELLISVILLE
MS
04927826
1932284312
PIERCE, DUJWANICE M NP
GULFPORT
MS
00014774
1831120724
PIERCE, III, PAUL W MD
VICKSBURG
MS
06581329
1821005265
PIERCE, IV, PAUL W MD
VICKSBURG
MS
06026713
1972858819
PIERCE, MONICA J MSN
JACKSON
MS
02559593
1922237411
PIERCE, SAMUEL MD
VICKSBURG
MS
07803337
1689646853
PIERCE, VINTON D MD
TUPELO
MS
00126965
1407897929
PIERCE, VIVIEN
LAUREL
MS
00350213
1700814514
PIERCE-POUNS, JANICE M CANP
JACKSON
MS
09434726
1407123961
PIERPONT, CARLA M NP
BILOXI
MS
07603579
1053751370
PIERRE, DAVID C MD
JACKSON
MS
02133361
1215381769
PIERSANTI, ALANA D MD
JACKSON
MS
00115396
1487625703
PIGOTT, CHARLES G
TUPELO
MS
09938503
1528221009
PILKINGTON, VICKY D MD
JACKSON
MS
00123643
1659306124
PILLOW, WILLIAM P MD
TUPELO
MS
04150773
1457364556
PIMPERL, LOYD C MD
LAUREL
MS
07053269
1669669446
PINION, DONNA B CFNP
GREENVILLE
MS
00118964
1356367312
PINKARD, NANETTE B MD
JACKSON
MS
02400869
1992942353
PINKERTON, EMILY R NP
LUCEDALE
MS
245
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04771268
1255364733
PINKERTON, JAY S MD
LUCEDALE
MS
00126150
1447271481
PINON, RAUL A
MCCOMB
MS
00114895
1629049846
PINSON, TERRY W MD
TUPELO
MS
05606000
1841296423
PINSON, THOMAS B MD
MERIDIAN
MS
00117957
1386604676
PINTO, KIRSTEN M NP
BILOXI
MS
03156077
1972791978
PIPKIN, JEFFREY A FNP-C
NEW ALBANY
MS
00623210
1649201591
PIPPEN, SHERRY C DMD
MONTICELLO
MS
02054091
1073992160
PIPPIN, KELLY D MD
JACKSON
MS
09584206
1487033403
PIPPIN, ZACHARY C MD
JACKSON
MS
02153552
1912950320
PIRACHA, MUZAFFAR MD
GULFPORT
MS
00123600
1649206392
PISCIOTTA, VINCENT MD
BILOXI
MS
00116830
1184667578
PITCOCK, ROBERT V MD
OXFORD
MS
00118217
1295779007
PITRE, BRIAN R MD
BILOXI
MS
02421250
1356673917
PITTMAN, AMANDA K ATC
JACKSON
MS
04754728
1205915428
PITTMAN, DONNA K FNP
RIDGELAND
MS
03003545
1063812220
PITTMAN, HANNAH P FNP
EUPORA
MS
01273350
1215038534
PITTMAN, SHANNON D MD
JACKSON
MS
00117495
1942207014
PITTMAN, TRACY B MD
OCEAN SPRINGS
MS
04482745
1821416280
PITTS, ALLISON M PA-C
JACKSON
MS
02423564
1295270213
PITTS, CELESTE M FNP
BEAUMONT
MS
02233770
1669781332
PITTS, ELIZABETH FNP
NEWTON
MS
00209037
1134271315
PITTS, EMBER NP
GULFPORT
MS
05628370
1467729293
PITTS, KAREN FNP
HATTIESBURG
MS
03880072
1891107702
PITTS, KRISTEN D MD
JACKSON
MS
00119100
1528176823
PITTS, LANE J MD
HATTIESBURG
MS
00115316
1699714311
PITTS, TERRY C DO
LAUREL
MS
03737356
1932570074
PITTS-THOMAS, NATAYLA FNP
SHAW
MS
01975567
1265517056
PIZZIMENTI, DAVID V DO
CORINTH
MS
246
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02935065
1356735450
PLANT, JOSHUA D MD
JACKSON
MS
00127076
1649272782
PLAVAC, THOMAS G MD
MERIDIAN
MS
06524884
1346466596
PLOTT, ERIC V MD
MERIDIAN
MS
00119361
1861569915
PLUNKETT, DANIEL K MD
GREENWOOD
MS
00118234
1902919756
PLUNKETT, KAREN W
GRENDA
MS
05976873
1669420238
POCREVA, JOSEPH A MD
PASCAGOULA
MS
00124231
1245290386
POE, KATRINA N
KILMICHAEL
MS
07900734
1669440509
POE, LARRY B MD
HATTIESBURG
MS
04305201
1780840298
POKHREL, NARAYAN MD
JACKSON
MS
01878802
1427066455
POLAND, SANDRA J CNM
MERIDIAN
MS
00114889
1427082106
POLCHOW, THURMAN N MD
PASCAGOULA
MS
04738364
1235102906
POLE, GINGER L DO
TUPELO
MS
06783777
1386039691
POLISKIN, MICHELE C MD
JACKSON
MS
00660432
1033131487
POLK, JASON L DMD
RICHLAND
MS
00660433
1447272802
POLK, LEXI DMD
RICHLAND
MS
02807261
1174786651
POLLARD, JAMES D MD
JACKSON
MS
00051807
1669482014
POLLES, JIM H DMD
JACKSON
MS
08338752
1932308327
POLSON, JAMES R FNP
JACKSON
MS
02559313
1548458367
POMEROY III, WILLIAM L MD
GULFPORT
MS
00115340
1285617084
POMIERSKI, DAVID A MD
MERIDIAN
MS
05852094
1548400781
POND, RYAN M MD
TUPELO
MS
03674046
1275086456
PONGETTI, JESSICA L DMD
OXFORD
MS
04159045
1083159099
PONTIUS, AMY L NP
OCEAN SPRINGS
MS
00122580
1811932072
POOLE JR, CALVIN P
MEADVILLE
MS
06957342
1114395050
POOLE, CHRISTINA NP
WEST POINT
MS
00010202
1679583157
POOLE, GALEN
BRANDON
MS
00909269
1114281680
POOLE, MEGHAN P MD
JACKSON
MS
07280205
1861815623
POOLE, MICHELLE A FNP
TOCCOPOLA
MS
247
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01102219
1932467792
POOSARLA, TEJA MD
JACKSON
MS
00016357
1730220815
POOTHULLIL, THOMAS M MD
BILOXI
MS
03789760
1467875625
POPE, KIMBERLY N CNP
MCCOMB
MS
00016876
1528099413
PORTER JR, WILLIAM C MD
VICKSBURG
MS
03258395
1588856959
PORTER, ANN M NP
JACKSON
MS
07377091
1184894354
PORTER, GARY S NP-C
DIAMONDHEAD
MS
04586756
1356489272
PORTER, MARY E FNP
FLOWOOD
MS
00124068
1407833221
PORTER, WANDERFUL E
TUPELO
MS
00111482
1770695108
PORTERA, JOHN M DPM
GREENVILLE
MS
00087725
1619078771
PORTERA, JOSEPH P
GREENVILLE
MS
00809533
1437312915
PORTIS, RAYMOND MD
VICKSBURG
MS
00115736
1659439867
PORTNER, MICHAEL E MD
CLEVELAND
MS
00060141
1205051315
POSEY JR, RUDOLPH A DMD
PHILADELPHIA
MS
02055549
1447237409
POSEY, EULA D CFNP
HATTIESBURG
MS
00064435
1952441909
POSEY, HALSEY D DDS
WEST POINT
MS
00126340
1013917103
POSEY, JON T MD
TUPELO
MS
05577721
1245644913
POSEY, KRISTEN S NP
JACKSON
MS
08103096
1821059676
POSTLER, MARK MD
GULFPORT
MS
05706756
1700861465
POTTER, JEFFREY N MD
HATTIESBURG
MS
08175511
1215957758
POTTER, RHONDA F CNP
GRENADA
MS
03588521
1154401172
POTTS-TOOMBS, DENESSA DMD
JACKSON
MS
08325864
1447674858
POUDEL, ATUL MD
JACKSON
MS
06552751
1740381045
POUND, CHARLES R MD
JACKSON
MS
03833021
1356712525
POUNDERS, MARY E FNP-C
CORINTH
MS
00126951
1497875876
POUNDERS, TERRI A CFNP
NEW ALBANY
MS
08508791
1386626851
POWE, NICOLE M CNM
MERIDIAN
MS
02885847
1487036224
POWELL III, THOMAS S MD
JACKSON
MS
07877875
1679581052
POWELL, EILEEN PMHNP
GULPORT
MS
248
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00880035
1518021872
POWELL, GEORGE A OD
HOUSTON
MS
07358051
1164523932
POWELL, JAMES G MD
HATTIESBURG
MS
08129884
1285833129
POWELL, KENNETH P MD
JACKSON
MS
08623258
1386079713
POWELL, NATASHA NP-C
JACKSON
MS
00112991
1518921626
POWELL, RONALD E
WEST POINT
MS
02802767
1235508276
POWELL, SARAH M FNP
WEST POINT
MS
00884849
1922052711
POWELL, STELLA K MD
JACKSON
MS
00087005
1255323903
POWELL, THOMAS S OD
AMORY
MS
02031766
1396288197
POWER, MARY C NP
JACKSON
MS
04755061
1083027890
POYADOU, LETASIA A DMD
HATTIESBURG
MS
00117784
1669436242
PRASAD, AMIT
TUPELO
MS
02358061
1194164764
PRASADH, INDU MD
CLARKDALE
MS
08238394
1093033656
PRASANNA, MARGARET M FNP
FLOWOOD
MS
00016570
1588602718
PRATER, ALLIE L MD
NEW ALBANY
MS
00016899
1972564656
PRATER, WESLEY F M.D.
CANTON
MS
00017652
1043233372
PRATHER, JOHN W MD
CORINTH
MS
09983311
1942467337
PRATHER, SUSAN CFNP
GREENVILLE
MS
06075268
1114980042
PRATT, HEIDI D DO
WATER VALLEY
MS
00113458
1417953233
PRATT, JOSEPH L MD
CORINTH
MS
07109554
1609141811
PRAVEEN KUMAR, VALIPARAMBIL B MD
GRENADA
MS
00833769
1902256555
PRAYS, CARLOS A
HATTIESBURG
MS
06151003
1346537891
PRECHTER, SCOTT A MD
JACKSON
MS
06204861
1750723110
PREECE, JOHN P DO
CORINTH
MS
04000391
1962423715
PREM, ANAND M MD
JACKSON
MS
08380581
1144649567
PREMKUMAR, BEENA J MD
JACKSON
MS
09281595
1164748091
PRESLEY, MARCUS A MD
JACKSON
MS
04339363
1972693992
PRESLEY, MICHAEL L OD
NEW ALBANY
MS
00970578
1194157784
PRESLEY, SARA M NNP
JACKSON
MS
249
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05289710
1164625448
PRESSLER, JOE M MD
JACKSON
MS
04974267
1407112089
PRESSLEY MOSS, ALICIA M MD
CORINTH
MS
03786288
1609148212
PRESSLY, DELANE NP
LAUREL
MS
07670070
1548682271
PRESSON, EMILY G OD
IUKA
MS
00011060
1770689853
PRESTON, WILLIAM H MD
BOONEVILLE
MS
07673005
1770553448
PREWITT, LINDSEY J MD
MERIDIAN
MS
08001057
1710941315
PREWITT, MALINDA M MD
TUPELO
MS
00120923
1790881274
PRICE, AMY S MD
SALTILLO
MS
07306301
1366828733
PRICE, BRIANA H FNP
BROOKHAVEN
MS
06725783
1073572251
PRICE, BURTON D MD
GREENWOOD
MS
01601853
1891153441
PRICE, D W NP
JACKSON
MS
03533875
1295717817
PRICE, DEANNA I
MERIDIAN
MS
03179279
1932566742
PRICE, KWANZA A PMHNP
GREENWOOD
MS
02773798
1275884793
PRICE, MARTIN L NP
CHOCTAW
MS
08682529
1982044913
PRICE, MONICA D MSN
JACKSON
MS
04178340
1437178589
PRICE, TARA S NP
MCCOMB
MS
04832364
1477957918
PRICE, TIFFANY FNP
CHOCTAW
MS
00438897
1881806354
PRIDE, JEFFERY B DMD
JACKSON
MS
00125447
1841364577
PRINCE, ANDREA M MD
WHITFIELD
MS
05103351
1215476064
PRINCIOTTA, JONATHAN D ACNP
JACKSON
MS
05275328
1083869218
PRINGLE, CANDACE B CNM
MERIDIAN
MS
00116779
1356454334
PRINGLE, CHARLES K MD
RIDGELAND
MS
00125077
1043321920
PRIOR, DONALD S MD
GREENVILLE
MS
00018072
1467626390
PRITCHARD, DOUGLAS A
TUPELO
MS
00735714
1417998774
PRITCHARD, RONALD S MD
GREENVILLE
MS
00051064
1730358201
PRIVE, BRUCE P NP
BILOXI
MS
07689072
1477864585
PROBST, CHARLES E DO
ELLISVILLE
MS
00015652
1598744773
PROCTOR, BARBARA J MD
JACKSON
MS
250
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09150777
1801006960
PROCTOR, BOBBY E MD
HATTIESBURG
MS
00115248
1538277843
PROLI, JOSEPH A
LAUREL
MS
07052555
1073578886
PROSSER, HARMON S MD
ACKERMAN
MS
00880004
1093901761
PRUDHOMME, DAVID L OD
VICKSBURG
MS
00123423
1700978889
PRUITT, CHARLES MD
MAGEE
MS
05981594
1598876161
PRUITT, ELEANOR K DMD
WHITFIELD
MS
05256859
1679577555
PRUITT, KATHRYN C NP
FLOWOOD
MS
01738731
1396163713
PRUITT, LOUIS G MD
VICKSBURG
MS
08379272
1295738706
PRUITT, TIMOTHY M APN
SOUTHAVEN
MS
03808054
1568858322
PRUST, RACHEL L WHNP-
TUPELO
MS
00122046
1932254547
PRYOR JR, SHAPARD H MD
JACKSON
MS
04284891
1306158183
PRYOR, JASON E MD
STARKVILLE
MS
03628357
1376709865
PRYOR, KAREN L NP
MCCOMB
MS
02481772
1063617835
PUCHAEV, MICHAEL MD
SOUTHAVEN
MS
00111106
1104808732
PUCKETT, MARTHA M
DE KALB
MS
04830214
1942695929
PUCKETT, TARA C NP-C
COLDWATER
MS
00120180
1841308160
PUCKETT, THOMAS G MD
HATTIESBURG
MS
00060242
1134213721
PUDDISTER, MICHAEL M DMD
NATCHEZ
MS
02058378
1679621411
PUGH, AMBER C MD
TUPELO
MS
04173532
1114085776
PUGH, JANET D FNP
MERIDIAN
MS
06877724
1518911445
PUJARI, ACHYUTHA S M.D.
ELLISVILLE
MS
02852230
1942400403
PULLEN, ASHLEY B MD
MADISON
MS
00660075
1003977281
PULLEN, BARNEY L
WATER VALLEY
MS
05479254
1952493546
PULLIAM, JOE S
GREENVILLE
MS
07338051
1114975505
PULLIAM, PRISCILLA E FNP
BROOKHAVEN
MS
00059747
1528056637
PUMMER, TERRY L DO
GRENADA
MS
00113407
1619913928
PUNEKY, LOUIS V MD
JACKSON
MS
00115892
1558369645
PUPA, SANDRA H MD
MERIDIAN
MS
251
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09702355
1811213853
PURCELL, ANN E FNP
JACKSON
MS
07872818
1235241183
PURCELL, DAVE M MD
VICKSBURG
MS
07375770
1992773675
PURDY, CHARLES R MD
MERIDIAN
MS
00115336
1598865206
PURDY, JAMES J MD
MERIDIAN
MS
06450702
1235418195
PURNELL, LAKECIA CFNP
GREENWOOD
MS
00015803
1902990997
PUROHIT, PURNIMA R M.D.
BATESVILLE
MS
00015687
1275627267
PUROHIT, RAMESH C MD
BATESVILLE
MS
00029267
1689876864
PURSER, AMANDA K FNP
JACKSON
MS
04121841
1457773400
PURSER, HOLLY WHNP
AMORY
MS
04170715
1073891925
PURSLEY, TARA C DMD
HATTIESBURG
MS
08425307
1023028925
PURVIANCE III, HOLLIS L CFNP
JACKSON
MS
08804774
1891236725
PURVIANCE, CHRISTINA D NP
JACKSON
MS
00201815
1386772283
PURVIS, CHERRYL D NP
GULFPORT
MS
08131707
1164409710
PURVIS, EDWIN M
MERIDIAN
MS
00120150
1629189998
PURVIS, JAMES K MD
JACKSON
MS
00119693
1063402782
PURVIS, JANI L MD
BROOKHAVEN
MS
00112802
1831102946
PURVIS, JOHN M M.D.
JACKSON
MS
00118517
1851495295
PURVIS, RONNYE D MD
MERIDIAN
MS
07400813
1780889576
PUSKARICH, MICHAEL A MD
JACKSON
MS
08230889
1629466131
PUTNAM, MARY P NP
BILOXI
MS
00014401
1093883795
PUTNAM, THOMAS J MD
BOONEVILLE
MS
03620721
1649279761
PYKE, O'NEIL MD
WEST POINT
MS
02728231
1538472576
QADAN, REGINA N MSN
JACKSON
MS
04620058
1679783088
QAISI, MOHAMMED K MD DM
JACKSON
MS
07822231
1427442391
QI, XIN MD
JACKSON
MS
01573550
1790780716
QU, GUANGZHI
JACKSON
MS
08672375
1669784930
QUALLS, JUSTIN A MD
JACKSON
MS
02632330
1699084020
QUARLES, AMANDA S CFNP
JACKSON
MS
252
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04300750
1235436577
QUARLES, DAVID T MSN
JACKSON
MS
08089010
1881960136
QUAVE, LAUREN A NP
BILOXI
MS
00115992
1841301116
QUDDUS, FAUZIA F MD
OCEAN SPRINGS
MS
08129237
1336257690
QUELER, ANDREW M MD
HATTIESBURG
MS
05878529
1952795403
QUIGLEY, RAE R MD
JACKSON
MS
01537021
1225219405
QUIN, STEVEN B MD
LAUREL
MS
00060078
1518032432
QUINN, KEISHA D DDS
LAUREL
MS
00076364
1750570677
QUINN, MELINDA L
FALKNER
MS
03620330
1447350483
QUINN, TIMOTHY M MD
RIDGELAND
MS
09689816
1477949097
QUINN, TONYA H NP-C
FLORENCE
MS
00118272
1902895352
QUINONES, EDWIN M
GULFPORT
MS
04854276
1124043641
QUINTANA, HUGO A MD
PASCAGOULA
MS
03385249
1386689974
QUINTON, WILLIAM N DMD
GREENVILLE
MS
04507321
1275536252
QUON, DANIEL DMD
JACKSON
MS
00123670
1467595843
QUON, DEXTER H MD
OXFORD
MS
02308225
1780766295
QURESHI, FAIZA N
JACKSON
MS
00125117
1912098781
QURESHI, NASEEM A MD
JACKSON
MS
07154773
1457326548
RAAB, STEPHEN S MD
JACKSON
MS
05877533
1740691831
RABALAIS, JAMES G MD
JACKSON
MS
09550593
1083630040
RABALAIS, ROBERT D MD
WOODVILLE
MS
00405585
1700075140
RABY, TERESA S NP
OXFORD
MS
02188840
1396158390
RACEY, SHERRY N DMD
COLLINS
MS
02870205
1639194566
RACK, MICHAEL J
FLOWOOD
MS
08585290
1194768994
RAFF, JOHN B MD
GULFPORT
MS
00116022
1871607598
RAFIQUE, SYED S MD
GREENWOOD
MS
08283843
1205092525
RAGAN, FREDERICK P MD
NATCHEZ
MS
00062180
1669501706
RAGAN, ROBERT T
CLEVELAND
MS
06178710
1265493332
RAGGIO, MICHAEL J MD
HATTIESBURG
MS
253
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03152342
1033406582
RAGLAND, KATHERINE L MD
JACKSON
MS
05152549
1164719621
RAGLAND, TIMOTHY J MD
JACKSON
MS
00118653
1578615001
RAGULA, ANDREW A
OCEAN SPRINGS
MS
01626828
1518214915
RAHAIM, JAMES A DMD
BAY ST LOUIS
MS
00114775
1336145762
RAHAT, MUZAFFAR MD
MERIDIAN
MS
00019413
1053402610
RAHMAN, MAHFUZUR MD
SOUTHAVEN
MS
08124727
1164885760
RAHMAN, MUHAIMINUR DO
JACKSON
MS
00123412
1679507024
RAHMAN, NAIM U
MACON
MS
04026718
1104241686
RAINES, CARMEN R FNP-C
TUPELO
MS
09153868
1588693634
RAINES, KATHERINE M NP
JACKSON
MS
00117994
1922009810
RAINES, MILTON R MD
GULFPORT
MS
03207054
1841601911
RAINEY, JEREMY T DO
JACKSON
MS
04179097
1063624948
RAINEY, RICHARD D MD
JACKSON
MS
00087012
1407835408
RAINS, CHRIS K
BILOXI
MS
07480290
1023378494
RAINS, MARCELO E MD
JACKSON
MS
00014060
1215960414
RAJU, SESHADRI MD
FLOWOOD
MS
00884367
1336302223
RALPH, JERMAINE C MD
MERIDIAN
MS
04685506
1083875132
RAM, SUNDEEP K DO
NATCHEZ
MS
00839093
1932506599
RAMADHAS, ANUSHA MD
JACKSON
MS
08980094
1689967036
RAMARAO, SUMANA MD
JACKSON
MS
06608238
1386933000
RAMIREZ, DANIEL E MD
JACKSON
MS
00954713
1518127034
RAMIREZ-SALDANA, ILIANA MD
JACKSON
MS
06972860
1265744270
RAMSEY, BRAD J DO
WAYNESBORO
MS
00014471
1508919648
RAMSEY, CALVIN MD
LEXINGTON
MS
08487562
1003884305
RAMSEY, CARL S MD
MERIDIAN
MS
07102249
1407937287
RAMSEY, CHARLES E DMD
JACKSON
MS
00124546
1376531582
RAMSEY, JAMES R
JACKSON
MS
02332254
1427502426
RAMSEY, JOSHUA W FNP
BOONEVILLE
MS
254
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06931595
1821024241
RAMSEY, KALISA K NP
JACKSON
MS
05680313
1336405455
RAMSEY, STACIE L NP
GULFPORT
MS
04600368
1336247816
RANDLE, ERIC D OD
HOLLY SPRINGS
MS
00124228
1497769665
RANDLE, GERALD P MD
JACKSON
MS
00118926
1184675134
RANDLE, JAN S
LOUISVILLE
MS
00087048
1114958758
RANDLE, STEVE OD
AMORY
MS
00116695
1275632325
RANDOLPH, RICHARD C MD
BRANDON
MS
00126200
1205812682
RANGI, NAVDIP S
OLIVE BRANCH
MS
03458053
1649213471
RANKIN, KEMILY A DO
VICKSBURG
MS
03781753
1518114958
RANSOM, C L FNP
JACKSON
MS
00118632
1396833398
RANSOME-KUTI, OLUGBOYEGA O
MERIDIAN
MS
05287337
1083930911
RAO, DEEPIKA S MD
JACKSON
MS
00121499
1619936218
RAO, GUTTI J MD
WINONA
MS
04538555
1972597961
RAPPAI, MARIA MD
JACKSON
MS
02723077
1992011506
RASMUSSEN, MELISSA L OD
CANTON
MS
02151260
1730476060
RATCLIFF, CHARLES D DMD
JACKSON
MS
08226516
1629012034
RATCLIFF, KIMBERLY R
BENTON
MS
00060169
1952348476
RATHER, HUGH H
HOLLY SPRINGS
MS
00016909
1871597385
RATLIFF, DONALD W MD
BELMONT
MS
01224584
1255753059
RATLIFF, RACHEL N NP
JACKSON
MS
00119562
1528075868
RATLIFF, ROGER D MD
AMORY
MS
06324817
1154563005
RATLIFF, VICKI A CFNP
FLOWOOD
MS
09120711
1285894196
RAU, JEREMY M MD
PICAYUNE
MS
08234897
1689766719
RAUCHER, SANJA
JACKSON
MS
07753202
1003055617
RAULS, RACHEL L FNP-B
OCEAN SPRINGS
MS
00123672
1003997396
RAUSA, ALFIO MD
GREENWOOD
MS
05123790
1790045375
RAUSH, NICHOLAS C MD
HATTIESBURG
MS
00017663
1386647436
RAWLINGS, ERMAN F MD
PASCAGOULA
MS
255
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00012833
1659380673
RAWSON, JAMES S MD
COLUMBUS
MS
03127515
1306147947
RAY JR, RICHARD B PMHNP
HATTIESBURG
MS
01128277
1124406681
RAY, AMRITA DO
JACKSON
MS
06608712
1730520842
RAY, DAVID M MD
JACKSON
MS
04878574
1023404100
RAY, HANNAH M MD
JACKSON
MS
00112345
1558342279
RAY, III, CHARLES A MD
MERIDIAN
MS
02421857
1043396591
RAY, JAMES A NP
GREENVILLE
MS
00111382
1316983760
RAY, LINDA I MD
JACKSON
MS
00115096
1922022060
RAY, MARK A MD
TUPELO
MS
04709739
1578733986
RAYBORN, KIMBERLY P FNP
GULFPORT
MS
08487858
1568732188
RAYBORN, NATHANIEL W NP
BILOXI
MS
00119934
1992782304
RAYBOURN, TERESA A
HATTIESBURG
MS
03253066
1083782064
RAYBURN, CHRISTINE T DMD
BOONEVILLE
MS
00660449
1407064306
RAYBURN, HARRY J DMD
TUPELO
MS
00117048
1154359842
RAYFORD, EDITH F MD
JACKSON
MS
00119495
1760496467
RAYFORD, RICHARD
JACKSON
MS
01985736
1053548545
RAYFORD, VERNON MD
TUPELO
MS
00127083
1821103151
RAYFORD, WALTER M.D.
SOUTHAVEN
MS
00123590
1922101328
RAYUDU, SREEDHAR R MD
BATESVILLE
MS
00018693
1083725618
RAYUDU, SUBBULAXMI MD
BATESVILLE
MS
00118254
1699785188
RAZA, SAYED A
RIDGELAND
MS
02085055
1427233196
RAZA, SHAHNILA MD
SOUTHAVEN
MS
00012932
1619084936
REA, JEANNE A MD
MCCOMB
MS
08959701
1306035910
REA, MISTY N MD
TUPELO
MS
05403741
1750696498
READY, MISTI L NP-C
JACKSON
MS
01700380
1962950303
REAVES, ASHLEY D NP
GULFPORT
MS
03071825
1245520352
RECORE, THOMAS V MD
WHITFIELD
MS
01971320
1316151475
RECTOR, JASON S DMD
BILOXI
MS
256
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04887324
1447565064
REDD, RITA R MD
MERIDIAN
MS
09451071
1649510090
REDDING, CAYCE L FNP
CORINTH
MS
04308352
1801200134
REDDITT, LEE E DMD
VANCLEAVE
MS
00011019
1619981107
REDDIX, CARL M MD
JACKSON
MS
00019089
1437163854
REDDIX, MICHAEL A MD
JACKSON
MS
04458570
1194934182
REDDY, SUJITH K MD
FLOWOOD
MS
00114375
1528176807
REDMON II, SIMON P FNP
SEMINARY
MS
01002054
1992904627
REDMOND, JEFF S MD
PICAYUNE
MS
01029796
1366882789
REDMOND, PAUL M MD
JACKSON
MS
00118205
1780682807
REDMOND, TERESA B
MERIDIAN
MS
00116295
1609853647
REECE, KAREN
SEBASTOPOL
MS
09426755
1275866261
REECE, KRISTI E NPL
IUKA
MS
07033864
1154354603
REED DUDLEY, SHINITA Y
JACKSON
MS
07836065
1811004914
REED HEARN, TINA R
BROOKHAVEN
MS
00119694
1649341256
REED, ANN M NP
DIAMONDHEAD
MS
05871552
1730555699
REED, CALLIE S CNP
CLEVELAND
MS
09136723
1013107762
REED, CHRISTOPHOR D MD
JACKSON
MS
07906092
1093826349
REED, DAVID A DO
TUPELO
MS
05457340
1902877608
REED, JOHN M
JACKSON
MS
07430203
1649423211
REED, JOHN M OD
MAGEE
MS
00111960
1235171091
REED, JR, WILLIAM R
TUPELO
MS
09505020
1063458412
REED, JULIE D NP
COLUMBUS
MS
08406567
1871802678
REED, KYLE J DMD
FLOWOOD
MS
05826531
1285639955
REED, LORI K MD
JACKSON
MS
00014184
1780755173
REED, ROGER H MD
GULFPORT
MS
07502301
1487852034
REED, RUSSELL J MD
JACKSON
MS
00122010
1427034610
REED, SANDRA J MD
SOUTHAVEN
MS
00880069
1598728800
REED, STEVEN T OD
MAGEE
MS
257
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00087760
1194927301
REESE, FRANK E OD
CLEVELAND
MS
03729287
1205051547
REESE-LYONS, WINTER M DMD
JACKSON
MS
07276341
1609062355
REEVES, AMANDA A MD
FLOWOOD
MS
00117488
1376658443
REEVES, DAVID L M.D.
LONG BEACH
MS
00660321
1801995378
REEVES, GARY W
JACKSON
MS
04088365
1477564664
REEVES, ROY R DO
POPLARVILLE
MS
00118103
1194713529
REEVES-DARBY, VONDA G MD
FLOWOOD
MS
04170036
1578756755
REHMAN, TAYYAB MD
GREENVILLE
MS
07826537
1326460122
REHOR, MICHAEL NP
GULFPORT
MS
00111001
1053397935
REID, DAVID H MD
OLIVE BRANCH
MS
00115342
1770565798
REID, KENNETH J
MERIDIAN
MS
00113431
1114063336
REID, RANDALL K MD
JACKSON
MS
00112675
1528086857
REID, RICHARD C
GRENADA
MS
00660073
1790832244
REID, THOMAS R DMD
BROOKHAVEN
MS
00116454
1760469340
REID, WILLIAM F MD
MERIDIAN
MS
00115838
1164525309
REIMUND, ERIC L MD
VICKSBURG
MS
03224552
1396057618
REINERS, ERIC M MD
JACKSON
MS
05676700
1184787673
REINHARD, ELAINE R
PORT GIBSON
MS
00114869
1811939614
REINSHAGEN, JERALD A MD
HATTIESBURG
MS
01521367
1588647150
REMAK, GEZA M.D.
SOUTHAVEN
MS
00064860
1851452080
REMBERT, ALVIN W DMD
JACKSON
MS
00113831
1891805347
REMLEY, DAVID B
FLOWOOD
MS
00120826
1073682035
RENFROE, DOYLE L
OXFORD
MS
00113599
1144371725
RENICKS, MICHAEL S
OCEAN SPRINGS
MS
00127101
1861580557
RENO III, WILLIAM L MD
HATTIESBURG
MS
04578323
1932157062
RERKO, DAVID MD
MERIDIAN
MS
06758008
1568545176
RESTER, BENJAMIN T MD
HATTIESBURG
MS
00121487
1538140512
RESTER, MARK O MD
BRANDON
MS
258
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08327830
1740413764
REVELS, CAREY L NP
HATTIESBURG
MS
06177318
1487835211
REY-DIOS, ROBERTO MD
JACKSON
MS
00012187
1700805553
REYNOLDS JR, GEORGE M MD
RIDGELAND
MS
00056851
1467842476
REYNOLDS, ALICIA M NP
GULFPORT
MS
05955081
1699093955
REYNOLDS, CHARLES A MD
BROOKHAVEN
MS
06156804
1154343481
REYNOLDS, CHRISTOPHER S MD
BOONEVILLE
MS
00010033
1962437046
REYNOLDS, DAVID S
HATTIESBURG
MS
00010036
1033144118
REYNOLDS, DENISE W MD
HATTIESBURG
MS
05932061
1609867209
REYNOLDS, JOEL C MD
MERIDIAN
MS
09807844
1730355967
REYNOLDS, JUDD M
HATTIESBURG
MS
00060310
1093937237
REYNOLDS, KEVIN M DMD
FOREST
MS
00060031
1770702144
REYNOLDS, RANDY DMD
FOREST
MS
01403363
1841511409
REZAYAT, TALAYEH DO
PASCAGOULA
MS
07457565
1568651289
RHEA, JENNIFER F CFNP
JACKSON
MS
02182554
1477907616
RHEA, LISA C NP
AMORY
MS
00121846
1871601062
RHEE, SUYON MD
HATTIESBURG
MS
00007319
1669760609
RHINEWALT, JAMES M MD
NEW ALBANY
MS
08227549
1285967547
RHINEWALT, TRACY B FNP
MADISON
MS
05126830
1043387764
RHODEN, CHAD A
JACKSON
MS
04802715
1750466876
RHODEN, SANDRA J MD
MADISON
MS
04459244
1205949047
RHODES, ERIN T DDS
HATTIESBURG
MS
08630002
1346558574
RHODES, KATHLEEN A NP
JACKSON
MS
09457208
1871933994
RHODES, KELLY L NP
BILOXI
MS
07752830
1629323142
RHODES, MEREDITH M OD
CORINTH
MS
08577562
1922479658
RHODUS, HEIDI NP-C
BRANDON
MS
00116932
1013024322
RIAD, ASHRAF E MD
MCCOMB
MS
09081242
1336113646
RICALDE, ORLANDO A MD
NATCHEZ
MS
02438020
1538214069
RICE III, ATWOOD L MD
GRENADA
MS
259
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02651302
1457513376
RICE, AMANDA R MD
HATTIESBURG
MS
02072547
1508995499
RICE, MICHELLE D NP
CALHOUN CITY
MS
00114577
1497888341
RICE, PAUL M MD
JACKSON
MS
00060325
1235349143
RICE, RICHARD T D.D.S
JACKSON
MS
09971729
1780911768
RICE, WILLIAM C MD
SOUTHAVEN
MS
00117095
1598735177
RICE, WILLIAM L MD
TUPELO
MS
01475571
1528449675
RICHARD, CHRISTOPHER J
TUPELO
MS
01772838
1700892346
RICHARD, JOSEPH H CFNP
MCCOMB
MS
00484777
1760892095
RICHARDS JR, THEODORE D DO
RIPLEY
MS
04507070
1427113273
RICHARDS, CAMILLE C NP
JACKSON
MS
01859794
1053554808
RICHARDS, JULIET W FNP
PASCAGOULA
MS
00017775
1114084241
RICHARDS, MELINDA CFNP
YAZOO CITY
MS
04105300
1992063846
RICHARDSON HARVEY, DANA S NP
GULFPORT
MS
02150825
1699956565
RICHARDSON JR, DONNIE J DMD
ABERDEEN
MS
00119592
1023067766
RICHARDSON, BETTY G
MCCOMB
MS
03482344
1598728586
RICHARDSON, BRADY L MD
KOSCIUSKO
MS
09723710
1962645770
RICHARDSON, BRECK MD
KOSCIUSKO
MS
00125352
1871601070
RICHARDSON, BRENTON G MD
HATTIESBURG
MS
02852024
1942640388
RICHARDSON, CHARLES D DO
JACKSON
MS
00016828
1568570117
RICHARDSON, CHARLES D MD
HATTIESBURG
MS
09426522
1629136221
RICHARDSON, CONNIE B CFNP
BILOXI
MS
06222050
1073670758
RICHARDSON, DANIEL Q M.D.
BILOXI
MS
03631714
1912994450
RICHARDSON, DAVID R MD
SOUTHAVEN
MS
05884373
1649588625
RICHARDSON, DIONNE J DDS
JACKSON
MS
01078012
1518981844
RICHARDSON, E S DDS
GRENADA
MS
00120095
1780627356
RICHARDSON, HARRY L MD
COLUMBUS
MS
06939583
1164683702
RICHARDSON, JENNIFER NNP
JACKSON
MS
07354065
1659775732
RICHARDSON, JENNIFER A FNP
ASHLAND
MS
260
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05600736
1972910321
RICHARDSON, JESSICA H FNP
WATER VALLEY
MS
00119784
1144230038
RICHARDSON, JOHN D
JACKSON
MS
09450543
1598218752
RICHARDSON, KATIE E OD
CORINTH
MS
00126201
1023118080
RICHARDSON, KEVIN M MD
MCCOMB
MS
07231029
1043634702
RICHARDSON, KRISTEN M PA
PETAL
MS
09536509
1417132689
RICHARDSON, LAKEISHA W MD
GREENVILLE
MS
03236316
1629418066
RICHARDSON, MARC A MD
JACKSON
MS
08051061
1457662702
RICHARDSON, MATTHEW A MD
JACKSON
MS
07674762
1285975094
RICHARDSON, NICHOLAS T OD
COLUMBUS
MS
01755591
1992943849
RICHARDSON, ONEKA Y MD
CORINTH
MS
07587237
1790173599
RICHARDSON, RACHEL A FNP
PHILADELPHIA
MS
07172838
1235457789
RICHARDSON, RACHEL R DO
BATESVILLE
MS
00123194
1013951987
RICHARDSON, RANDY K MD
OXFORD
MS
02350807
1598219669
RICHARDSON, REBECCA N FNP
STARKVILLE
MS
02203270
1457363780
RICHARDSON, RHONDA NP
LAUREL
MS
02552321
1992997159
RICHARDSON, RODNEY C
MERIDIAN
MS
00725516
1942564315
RICHARDSON, SPENCER D MD
JACKSON
MS
00120748
1922040195
RICHERT, ALLEN C
JACKSON
MS
00727505
1427206556
RICHEY, JANET A CFNP
TUPELO
MS
02032751
1417953050
RICHEY, STEVEN T MD
SOUTHAVEN
MS
05279741
1699779371
RICHIE, HEATHER L MD
HATTIESBURG
MS
08476255
1184819583
RICHMOND, JONATHAN D MD
TUPELO
MS
03508271
1649635467
RICHMOND, MONIQUE NP
FLOWOOD
MS
00602356
1356443071
RICKHEIM, PATRICK B DDS
BILOXI
MS
05784539
1225106701
RICKS JR, ALVIN T FNP
CHOCTAW
MS
00120460
1184663528
RICKS, BARBARA L MD
GREENVILLE
MS
00124046
1841284478
RICKS, JANET L DO
JACKSON
MS
08238055
1770874687
RICKS, KEVIN R MD
COLUMBUS
MS
261
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00018828
1083613210
RIDDELL, MAL S DO
GRENADA
MS
02030025
1427219799
RIDGEWAY, ROGER D MD
PASCAGOULA
MS
05952735
1134111867
RIDGWAY, MILDRED MD
JACKSON
MS
07181375
1205184447
RIELS, ANDREA L NP
HATTIESBURG
MS
00880223
1801918826
RIFFE, JIMMY A
OXFORD
MS
03505897
1376545145
RIFKIN, BRIAN S MD
HATTIESBURG
MS
00121392
1427073386
RIGDON, EDWARD E MD
BRANDON
MS
00608592
1821243924
RIGDON, HOLLY C NP
COLUMBUS
MS
05088061
1215339080
RIGDON, JENNIFER C CFNP
WEST POINT
MS
02338063
1497124432
RIGDON, LEE H NP
HATTIESBURG
MS
06479238
1942659735
RIGDON, LINDSEY N NP
MERIDIAN
MS
08927049
1326488024
RIGNEY, DEBBIE A MD
JACKSON
MS
00118310
1407817240
RIGSBY, REGINALD D M.D.
LEXINGTON
MS
00013679
1740277110
RIIKOLA, ROBERT W MD
SOUTHAVEN
MS
03238237
1851375489
RIKABI, KHALED A MD
BILOXI
MS
00050524
1841538030
RILEY, AMBER S FNPC
SHUBUTA
MS
00305308
1568574457
RILEY, ANGELA M MD
COLUMBUS
MS
06033851
1366541872
RILEY, JULIA E MD
PHILADELPHIA
MS
01274311
1669884649
RILEY, RACHEL E MD
JACKSON
MS
03504366
1619976636
RIMMER, DAVID M MD
BAY ST LOUIS
MS
08582225
1346698503
RINER, TIFFANY R NP-C
CORINTH
MS
00119314
1740226117
RINKER, RONALD D MD
PASCAGOULA
MS
01253351
1346403466
RIPPEL, SARA W MD
FLOWOOD
MS
02388000
1003020348
RIPPON, JENNIFER DO
GULFPORT
MS
04124361
1295172989
RISCO, ERIN M NP
BILOXI
MS
00010871
1639212541
RISER, JAMES M MD
PICAYUNE
MS
00114984
1972567428
RISH, JAMES A MD
TUPELO
MS
08551791
1164584223
RISH, RACHEL W CNP
HOULKA
MS
262
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06830823
1184858680
RISHER, NANCY H FNP
MERIDIAN
MS
00122396
1164500732
RISLEY III, WALTER P
OCEAN SPRINGS
MS
09075224
1699836791
RIVERA, YURI O PA
PURVIS
MS
02304761
1376713313
RIVERO, GINA F
PICAYUNE
MS
08531841
1386055705
RIVERO, JULIE T MD
JACKSON
MS
02401057
1598968182
RIVES, CRISTIE G DMD
MENDENHALL
MS
06286014
1447407895
RIVES, SHANNON NP
JACKSON
MS
00121861
1568411403
RIZK, ANTOINE B MD
GULFPORT
MS
08204373
1720092877
RIZK, SIMON G MD
PASCAGOULA
MS
07830345
1124306642
RIZVI, TANVIR MD
JACKSON
MS
00115844
1124045679
RIZWAN, MOHAMMAD MD
VICKSBURG
MS
00458310
1649442484
RIZZO, ELIZABETH B CFNP
RULEVILLE
MS
00116781
1376561779
ROACH, RICKY P DPM
BILOXI
MS
04700200
1417009382
ROARK, KINESHIA A
HATTIESBURG
MS
08106745
1164863262
ROARK, MICHELLE L CNM
MERIDIAN
MS
00015897
1407848690
ROBBINS III, JAMES S MD
GREENWOOD
MS
03156350
1669464863
ROBBINS, APRIL NP
JACKSON
MS
00124207
1295843449
ROBBINS, BRETT MD
HATTIESBURG
MS
03022127
1144293655
ROBBINS, DAVID B PA-C
NEW ALBANY
MS
00125946
1578773800
ROBBINS, JOE K MD
CANTON
MS
00122998
1639255284
ROBBINS, KENNY K MD
JACKSON
MS
09689047
1013145820
ROBBINS, PATRICK J MD
JACKSON
MS
00118222
1780792945
ROBBINS, ROBERT J MD
HATTIESBURG
MS
00019956
1437268075
ROBBINS, SUSAN LYNN
HATTIESBURG
MS
01488591
1265688865
ROBERSON, ANN C MD
JACKSON
MS
08124779
1629133400
ROBERSON, GARY A MD
WHITFIELD
MS
01951327
1871607812
ROBERSON, JOHN B DMD
HATTIESBURG
MS
00064888
1720098510
ROBERSON, RONAL F DMD
CHARLESTON
MS
263
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04977346
1619139474
ROBERSON, ROWLAND M MD
TUPELO
MS
00123147
1083628291
ROBERTS JR, JAMES E MD
BROOKHAVEN
MS
00783030
1730468273
ROBERTS JR, JAMES G FNP
SOUTHAVEN
MS
00123681
1467596031
ROBERTS, ANNE A M.D.
HAZELHURST
MS
02687720
1770570038
ROBERTS, BRUCE E MD
JACKSON
MS
01377321
1154722569
ROBERTS, CHRISTINE H CFNP
JACKSON
MS
06473768
1457706913
ROBERTS, DANA M NP
LEXINGTON
MS
00122432
1932118965
ROBERTS, DAVID F MD
DIAMONDHEAD
MS
05656054
1588031421
ROBERTS, EMILY D NP
NATCHEZ
MS
05021856
1528223005
ROBERTS, JENNIFER R DO
LAUREL
MS
01704800
1336393891
ROBERTS, JESS MD
JACKSON
MS
02078267
1417110990
ROBERTS, JOHN V MD
TUPELO
MS
00115132
1023129608
ROBERTS, JOSEPH F
GRENADA
MS
02101001
1649525015
ROBERTS, KARAH H OD
MERIDIAN
MS
05904845
1275847873
ROBERTS, LASAUNDRA MHNP
MERIDIAN
MS
01682070
1538582531
ROBERTS, MARCELLA M CFNP
MCCOMB
MS
00123317
1174517007
ROBERTS, MELISSA B MD
HATTIESBURG
MS
05107335
1285902841
ROBERTS, MELONIE R NP
GULFPORT
MS
08333067
1821438813
ROBERTS, RACHEL MD
JACKSON
MS
05078069
1730443078
ROBERTS, RONALD B MD
JACKSON
MS
04389056
1295932473
ROBERTS, STEVEN B DMD
TUPELO
MS
00327268
1801026141
ROBERTSON III, GEORGE H MD
HATTIESBURG
MS
06556759
1396889721
ROBERTSON, AMY R NP
COLUMBUS
MS
00118818
1528154861
ROBERTSON, AUDREY U MD
JACKSON
MS
09322818
1003998303
ROBERTSON, CHARLES M MD
JACKSON
MS
00111465
1619073103
ROBERTSON, CHARLES R
TUPELO
MS
00120019
1851332217
ROBERTSON, CINDY L FNP
COLUMBUS
MS
00117375
1679517411
ROBERTSON, DENZIL G
JACKSON
MS
264
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01354773
1538297593
ROBERTSON, DONALD C MD
IUKA
MS
08571703
1568726958
ROBERTSON, ELLIOTT B MD
JACKSON
MS
09909850
1497070312
ROBERTSON, HESS M MD
JACKSON
MS
00064850
1619018462
ROBERTSON, HOWARD L DMD
SMITHVILLE
MS
08309829
1124427133
ROBERTSON, KIMBERLY FNP
LOUISVILLE
MS
07837890
1902132764
ROBERTSON, KRISTI L FNP
ABERDEEN
MS
03605748
1184086290
ROBERTSON, MICHAEL J MD
JACKSON
MS
00120194
1033221106
ROBERTSON, REBECCA T FNP
TUPELO
MS
08475276
1770808693
ROBERTSON, SARA B MD
JACKSON
MS
00118300
1790894335
ROBERTSON, SHERRI A DNP
ELLISVILLE
MS
08220715
1215019518
ROBERTSON, THERESA E MD
JACKSON
MS
06030052
1346680758
ROBICHAUX, ANDREW M MD
JACKSON
MS
07405001
1265799977
ROBIN, KERRI A NP
GULFPORT
MS
05754052
1043768005
ROBINETTE, BETHANY NP
FLOWOOD
MS
00064863
1053416370
ROBINSON JR, JOHN DDS
COLUMBUS
MS
07054761
1568683878
ROBINSON, AIMEE C MD
SOUTHAVEN
MS
04639538
1114399375
ROBINSON, BRANDI L FNP-C
MERIDIAN
MS
06136780
1972823359
ROBINSON, CASSIE C FNP
CORINTH
MS
00116159
1487631750
ROBINSON, CHARLES L MD
GULFPORT
MS
03681257
1972620375
ROBINSON, FREDRICK L
JACKSON
MS
02979213
1881857159
ROBINSON, JAMES N MD
SOUTHAVEN
MS
03933861
1760928097
ROBINSON, JAMIE E FNP
CORINTH
MS
04551345
1144687583
ROBINSON, JERAD NP-C
JACKSON
MS
04335743
1780038786
ROBINSON, KIZZY FNP-C
NATCHEZ
MS
09083527
1003984592
ROBINSON, KRISTY L FNP
CANTON
MS
04523548
1053355024
ROBINSON, LAURIE B FNP
FLORENCE
MS
06254252
1912219072
ROBINSON, LESLIE B FNP
YAZOO CITY
MS
08639584
1336495951
ROBINSON, MARIA NP
GULFPORT
MS
265
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08039832
1265796288
ROBINSON, RAIME M MD
JACKSON
MS
07551009
1295764793
ROBINSON, SAMUEL P MD
GULFPORT
MS
09484030
1447642335
ROBINSON, TANGA D NP
GREENWOOD
MS
05985016
1649536947
ROBINSON, TIMOTHY R ACNP
PASCAGOULA
MS
01953713
1952778359
ROBISON, JACOB T NP
ABERDEEN
MS
00660253
1366533283
ROBY, DARYL DMD
DURANT
MS
00116074
1629014113
ROCCONI, PAUL M MD
HATTIESBURG
MS
00015504
1659466274
ROCKHOLD, LINDA MD
JACKSON
MS
03805202
1710141767
RODA, MANOHAR S MD
JACKSON
MS
00019997
1861496507
RODGERS, CLIFTON MD
BYHALIA
MS
08527898
1871875831
RODGERS, RODNEY
TUPELO
MS
04385578
1548357643
RODGERS, SCOTT M MD
JACKSON
MS
08827865
1427599067
RODGERS-WALTON, SHERRITA NP
SOUTHAVEN
MS
09036365
1063836005
RODRIGUEZ GARCIA, GRETTEL R MD
HATTIESBURG
MS
05807263
1740473156
RODRIGUEZ PINEDA, OSCAR M MD
JACKSON
MS
00015456
1356322051
RODRIGUEZ, ANGEL A MD
CORINTH
MS
00123444
1184623886
RODRIGUEZ, JACK J MD
NATCHEZ
MS
05054344
1235232752
RODRIGUEZ, JENNIFER J MD
MERIDIAN
MS
09151072
1780779579
RODRIGUEZ, JOSE A MD
PICAYUNE
MS
05351053
1053577601
RODRIGUEZ, LIANA DO
BILOXI
MS
07858743
1154324366
RODRIGUEZ, RAY J MD
JACKSON
MS
01037751
1265806038
RODRIGUEZ, SONIA M NP-C
MERIDIAN
MS
08552562
1164434882
RODRIGUEZ-TORRES, ALFREDO
BRANDON
MS
00125446
1164434882
RODRIQUEZ-TORRES, ALFREDO MD
STARKVILLE
MS
05173541
1629223151
ROEBUCK, DANIEL C
OCEAN SPRINGS
MS
00115642
1720026784
ROFFWARG, HOWARD P
JACKSON
MS
01703226
1477995009
ROGERS, BRITTANY N OD
TUPELO
MS
06733780
1720092331
ROGERS, HERBERT G MD
LAUREL
MS
266
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04638265
1033340690
ROGERS, JAMES J MSN
LEXINGTON
MS
06378099
1588955348
ROGERS, JEREMY S DO
LAUREL
MS
00660176
1932279833
ROGERS, JOEY E DMD
COLLINS
MS
08632324
1134424385
ROGERS, MELISSA S NP
JACKSON
MS
00122791
1407930555
ROGERS, MICHAEL A
BRANDON
MS
09876063
1184000952
ROGERS, SHARONDA NP
FAYETTE
MS
02055887
1649549858
ROGERS, VIVIAN A NP
TUPELO
MS
00119563
1730196072
ROGERS, WILLIAM B MD
AMORY
MS
00114963
1760588446
ROGNESS, ANDREW H MD
HATTIESBURG
MS
09888547
1457576878
ROHMAN, KRISTIE S MD
MADISON
MS
00121581
1184600439
ROJAS, PHILIP A MD
OLIVE BRANCH
MS
05908739
1396927448
ROKA, ATTILA MD
MERIDIAN
MS
04277747
1194017509
ROLAND, EDWINA I NPC
PASCAOULA
MS
09532021
1033325022
ROLAND, MALCOLM M MD
OXFORD
MS
07408755
1750480307
ROLISON, CONNIE R
OCEAN SPRINGS
MS
09785898
1770521494
ROLISON, RACHEL D CFNP
NEW ALBANY
MS
00855040
1750779849
ROLLINS, TIASHIA T CFNP
LEXINGTON
MS
05759241
1861832909
ROMERO, JENNIFER G DMD
SENATOBIA
MS
02605308
1710976162
ROMERO, STEPHANIE D CFNP
GULFPORT
MS
00660005
1891842191
RONE, ROBERT H DMD
CRYSTAL SPRINGS
MS
00115442
1962451898
ROOKS, JAMES R MD
JACKSON
MS
08878817
1275597288
ROSA III, LOUIS MD
TUPELO
MS
00064018
1588715965
ROSALYN WHITE-GAMBRELL DDS
MERIDIAN
MS
05735373
1790926780
ROSE, ELIZABETH R MD
HATTIESBURG
MS
00829392
1780947127
ROSE, ERICA M DMD
HATTIESBURG
MS
08055700
1801150958
ROSE, JERRICK W DMD
FLORENCE
MS
00010055
1629088968
ROSE, JULIAN MD
RIDGELAND
MS
00576763
1942439542
ROSE, REBECCA A MD
BILOXI
MS
267
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00880191
1417956616
ROSE, SAMUEL OD
GREENWOOD
MS
04352798
1821192204
ROSE, THOMAS A MD
NATCHEZ
MS
00114777
1295826196
ROSE, WALTER H MD
INDIANOLA
MS
00118112
1083691489
ROSEBERRY, TRACY C WHNP
HATTIESBURG
MS
02904833
1124315742
ROSENBLATT, SUSAN C MD
JACKSON
MS
03520709
1689888745
ROSETTI, JASON O
GULFPORT
MS
00115691
1407888316
ROSS JR, JOE R MD
JACKSON
MS
07722861
1083085260
ROSS, ABBEY NP
GREENWOOD
MS
07723291
1871887984
ROSS, ALISON H DMD
OXFORD
MS
07520777
1114153723
ROSS, ANDREW S DMD
OXFORD
MS
08609266
1982782330
ROSS, APRIL M MD
PICAYUNE
MS
09709346
1336498732
ROSS, COLTEDRA S APN
OLIVE BRANCH
MS
06658561
1992149348
ROSS, DENETTA D FNP
JACKSON
MS
00010874
1447323001
ROSS, DIANE E MD
GULFPORT
MS
00660051
1578789616
ROSS, JAMIE E DMD
MORTON
MS
00124738
1578507133
ROSS, JEFFREY D MD
BROOKHAVEN
MS
08178571
1154477651
ROSS, JULIE APRN
MCCOMB
MS
08036306
1295097269
ROSS, KAREN C NP-C
LIBERTY
MS
09124271
1093797623
ROSS, LARA L
MERIDIAN
MS
01289839
1801933031
ROSS, LOUIE G FNP
FLOWOOD
MS
09227351
1588032437
ROSS, MELISSA H NP
OXFORD
MS
00011237
1518076157
ROSS, RANDOLPH J
HATTIESBURG
MS
00122695
1932100799
ROSS, ROBERT D MD
GULFPORT
MS
04733217
1043634744
ROSS, ROBYNN E FNP
SENATOBIA
MS
03333713
1154543627
ROSS, SARAH E MD
JACKSON
MS
00017890
1255462404
ROSS, WILLIAM MD
CORINTH
MS
00115091
1972617884
ROSS, WILLIAM S MD
MOSS POINT
MS
00064973
1235344631
ROSSETTI, DONALD J DMD
NEW ALBANY
MS
268
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00064974
1326253725
ROSSETTI, RONALD L DMD
NEW ALBANY
MS
00060081
1982626826
ROTEN SR, DONALD P DDS
RIPLEY
MS
09733845
1326094806
ROTEN, DONALD P MD
NEW ALBANY
MS
00116679
1013068212
ROTH, RANDY C MD
PASCAGOULA
MS
00116170
1053350678
ROTH, STUART T MD
OXFORD
MS
03979555
1629489679
ROTHENBURGER, LYNSEY M MD
JACKSON
MS
02801001
1285680264
ROUHBAKHSH, RAMBOD MD
HATTIESBURG
MS
04203864
1265414775
ROUNTREE, MARK A PA
HATTIESBURG
MS
00112871
1992737118
ROUSE, DOUGLAS W MD
HATTIESBURG
MS
00060456
1184693723
ROUSE, PAUL DDS
BILOXI
MS
06029863
1669854964
ROUTH, JANEE' A
TUPELO
MS
00087888
1245219245
ROUTT, LAWRENCE A OD
KOSCIUSKO
MS
00119940
1922075803
ROVIRA, KLAR A M.D.
PICAYUNE
MS
01203007
1639264302
ROWAN, DAVID K DMD
NEW ALBANY
MS
03576323
1508951286
ROWAN, KARA M DMD
FOREST
MS
07538525
1760877112
ROWE HOBBS, LAUREN M MD
JACKSON
MS
05672251
1689943235
ROWE, JENNIFER NP
NATCHEZ
MS
00064779
1386762797
ROWLAND, GUY F
RIDGELAND
MS
07835756
1508219221
ROWLAND, JACOB C PA
TUPELO
MS
02371512
1851671820
ROWLAND, TERRIE R CFNP
INDIANOLA
MS
00018758
1861565400
ROWLEN, DENNIS W MD
BRANDON
MS
05475099
1689791733
ROWSEY, MISTY R FNP
BOONEVILLE
MS
09537875
1801097019
ROY, DAVID B DO
WIGGINS
MS
00114159
1639115173
ROY, ELIZABETH N M.D.
VICKSBURG
MS
03957766
1013357334
ROYALS, KATHERINE O MD
HATTIESBURG
MS
00115139
1639221179
RS RUNNELS JR MD PPLC
FLOWOOD
MS
06778836
1164499109
RUBEL, BARRY S DMD
JACKSON
MS
00123321
1992710727
RUBENSTEIN, LOUIS A MD
OCEAN SPRINGS
MS
269
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08151343
1356380851
RUCKDESCHEL, JOHN C MD
JACKSON
MS
01738856
1982707337
RUDER II, JOSEPH E DDS
AMORY
MS
00122247
1629080627
RUFF, PAUL L
STARKVILLE
MS
00660392
1063594588
RUFFIN, DENISE R DDS
LIBERTY
MS
06929835
1821367053
RUGNATH, ANESH P MD
JACKSON
MS
08958599
1821280363
RUGNATH, DINESH N MD
HATTIESBURG
MS
09351545
1972606358
RUHL, FORSTER G
SENATOBIA
MS
05952816
1215922661
RUIZ JR, RESTITUTO S MD
PICAYUNE
MS
09233876
1922376623
RUIZ, ARNALDO L MD
JACKSON
MS
09982851
1942425459
RULEWICZ, GABRIEL J MD
TUPELO
MS
02832263
1770705204
RUMMAN, SYEDA S MD
BAY SAINT LOUIS
MS
03509503
1629141502
RUMMELS JR, DOUGLAS G DMD
FLOWOOD
MS
00123451
1881651131
RUNNELS SR, RUDOLPH S MD
MAGEE
MS
06983066
1215149711
RUNNELS, JOHN M MD
FLOWOOD
MS
03077029
1144532391
RUNNELS, MARK A MD
JACKSON
MS
05109208
1164759965
RUPERT, TYRONE L NP
COLUMBUS
MS
00875556
1790135721
RUPP, CRISTINA M NP
GULFPORT
MS
00110800
1780618686
RUSCH, JAMES A MD
GULFPORT
MS
00114504
1215996004
RUSCOE, DIANNE
GREENWOOD
MS
00014212
1376526178
RUSH III, GUSTAVUS A
MERIDIAN
MS
08175829
1790806578
RUSH, BENJAMIN T MD
MERIDIAN
MS
09707730
1396039434
RUSH, DAVID A MD
JACKSON
MS
06902572
1891183208
RUSH, KATIE D NP
PRENTISS
MS
09024300
1023417938
RUSHING, CARLA A NP
GULFPORT
MS
00116401
1891792842
RUSHING, ERIC L MD
JACKSON
MS
06820737
1649653247
RUSHING, JOHN S MD
JACKSON
MS
05436231
1205910718
RUSHING, KAPPI F FNPBC
MCCOMB
MS
04124350
1093053977
RUSHING, KARA N FNPC
NEW ALBANY
MS
270
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04802591
1184971046
RUSHING, RHONDA J NP
MCCOMB
MS
00113703
1881600492
RUSHING, STEVEN K
WINONA
MS
00115747
1790891679
RUSHING, WILLIAM R
BROOKHAVEN
MS
00013429
1194825323
RUSHTON JR, FRED W MD
JACKSON
MS
00121892
1619925666
RUSS, JENNIFER V MD
NATCHEZ
MS
02620394
1447412275
RUSSELL JR, EARL D NP
BROOKHAVEN
MS
00014396
1710909882
RUSSELL SR., DONALD B MD
AMORY
MS
02439201
1942266341
RUSSELL, BRADY R MD
TUPELO
MS
00123661
1891797932
RUSSELL, DAVE A MD
MERIDIAN
MS
00120719
1629072509
RUSSELL, GEORGE V MD
JACKSON
MS
03428243
1144416504
RUSSELL, JODI H FNP
BATESVILLE
MS
04834083
1821231663
RUSSELL, JOHN
OXFORD
MS
06050290
1013357458
RUSSELL, JR, HORACE A MD
JACKSON
MS
02228532
1992070825
RUSSELL, MORLYN T FNP-C
JACKSON
MS
00126047
1063584175
RUSSELL, RICHARD L MD
JACKSON
MS
03425740
1144331422
RUSSELL, ROBERT J MD
CLINTON
MS
00119498
1710969472
RUSSELL, RON C
MERIDIAN
MS
00001062
1831180900
RUSSELL, RYAN D
TUPELO
MS
00117682
1932219581
RUSSELL, SANDRA P
PETAL
MS
02672568
1629408463
RUSSELL-MCADORY, DENIECE CFNP
MOUND BAYOU
MS
01633507
1376951921
RUSSUM, JENNIFER H MSN
JACKSON
MS
01929538
1477642718
RUSTIN, CLARA J FNP
COLUMBUS
MS
07684765
1629300231
RUTHERFORD, JAMI C NP
BAY ST LOUIS
MS
00336272
1598132771
RUTHERFORD, KATESE NP
PONTOTOC
MS
00121942
1548263627
RYAN JR, CHARLES G M.D.
OLIVE BRANCH
MS
03309548
1164506168
RYAN, JAMES M FNP
GULFPORT
MS
05186068
1063896868
RYAN, TIMOTHY P MD
JACKSON
MS
07887232
1083866651
RYDER, KELLY DO
LAUREL
MS
271
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09055028
1821344771
RYDER, STEPHEN L PA
VANCLEAVE
MS
00620209
1568647006
SAAD, ALI G MD
JACKSON
MS
01283718
1265732515
SAATHOFF, ANGELA D CFNP
PEARL
MS
00117621
1932157591
SABATINO, BRUCE MD
CALHOUN CITY
MS
03375270
1003227026
SABER, MOHSIN N MD
JACKSON
MS
02354827
1861856668
SABHARWAL, ADITYA DO
JACKSON
MS
02421018
1194065797
SABINS, BETHANY B FNP-C
JACKSON
MS
06026855
1457739997
SABINS, JOSHUA NP
JACKSON
MS
00123562
1538169503
SACHDEV, VISHAL
TUPELO
MS
00019712
1497765705
SADDLER, LOUIS J MD
CANTON
MS
03879829
1639309685
SADIQ, SYED B MD
LAUREL
MS
05075784
1003062605
SAFLEY, JESSICA L MD
GULFPORT
MS
03559503
1568606176
SAFLEY, MATTHEW L DO
GULFPORT
MS
02654041
1386725570
SAGAR, PATEL H MD
JACKSON
MS
05076714
1548582455
SAIA, LAURA A PA
TUPELO
MS
01180079
1821452947
SAINT-VICTOR, MARVELL MD
JACKSON
MS
07031034
1932527264
SAKSA, BRANDI NP
GULFPORT
MS
07137290
1376777995
SALAM, OMAR S MD
GRENADA
MS
03283037
1659380970
SALAZAR, JORGE D
JACKSON
MS
04953566
1689015273
SALEH, KHALID MD
JACKSON
MS
05154788
1013075449
SALIM, MAZHAR MD
BRANDON
MS
09323562
1457658007
SALIM, SOHAIL A MD
JACKSON
MS
04989221
1003113606
SALLEY, SETH A OD
SOUTHAVEN
MS
00124267
1902827603
SALLOUM, GEORGE T MD
GULFPORT
MS
00116005
1205870656
SALLOUM, NAIM J
HATTIESBURG
MS
00124074
1942212840
SALMAN, MICHAEL T MD
MERIDIAN
MS
09426581
1457585739
SALMON, OLAYIWOLA A MD
GREENWOOD
MS
08353059
1750722724
SALSBURY, RYLAND S MD
JACKSON
MS
272
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08003866
1720522535
SAMMONS, MARION S NP-C
LAUREL
MS
00119301
1053426908
SAMMS, CHARLES G MD
GULFPORT
MS
00119501
1003838699
SAMS III, LUCIUS F MD
PEARL
MS
00119501
1003838699
SAMS III, LUCIUS F MD
BRANDON
MS
00121469
1386689404
SAMS, BRADLEY C MD
OCEAN SPRINGS
MS
05679044
1831199108
SAMSON, STUART F MD
LAUREL
MS
01926065
1427149210
SAMUEL, ELDON M MD
CHOCTAW
MS
06781511
1548459019
SAMUEL, EUREKIA D CFNP
BRANDON
MS
09027041
1447600721
SAN LUIS, CARMELA V MD
JACKSOM
MS
06527044
1801299425
SANANDAJIFAR, HASTI DO
JACKSON
MS
04129381
1952698318
SANAPUREDDY, PADMAJA MD
JACKSON
MS
00124277
1780660043
SANCHEZ, CARL T MD
OLIVE BRANCH
MS
00486207
1669812087
SANCHEZ, PATRICK J MD
JACKSON
MS
00121939
1427083971
SANDEFUR, MARK V MD
FLOWOOD
MS
09372043
1447579495
SANDERS, ALBERT H NP
PICAYUNE
MS
00173051
1396150017
SANDERS, BOBBI M FNP
TUPELO
MS
04431252
1710411376
SANDERS, CATHERINE R NP
JACKSON
MS
00805759
1689080715
SANDERS, COURTNEY E L MSN
JACKSON
MS
00051022
1760453997
SANDERS, DANNY L MD
TUPELO
MS
08208322
1295004497
SANDERS, DEANNA L FNP
TUPELO
MS
00017032
1992715676
SANDERS, DEBORAH MD
VICKSBURG
MS
02930813
1225008576
SANDERS, HOLLI A
TUPELO
MS
02984016
1376631556
SANDERS, IV, HENRY J MD
MCCOMB
MS
05102521
1043633696
SANDERS, JENNIFER C FNP
OLIVE BRANCH
MS
00382802
1255434460
SANDERS, KATHERINE L OD
DIBERVILLE
MS
02777259
1619424330
SANDERS, KISHINA S CFNP
RIDGELAND
MS
02381520
1124161849
SANDERS, LISA P CFNP
TUPELO
MS
00122353
1033128681
SANDERS, MICHAEL L M.D.
JACKSON
MS
273
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02675757
1922067107
SANDERS, NEEKA L MD
GREENWOOD
MS
08551340
1477783850
SANDERS, SARA S MD
JACKSON
MS
05082033
1558431163
SANDERS, SCOTT E OD
DIBERVILLE
MS
03885255
1629207170
SANDERS, SHAWN MD
JACKSON
MS
09389513
1215156203
SANDERS, WHITNEY L MD
SOUTHAVEN
MS
09255228
1154584811
SANDHU, JASMINE MD
BRANDON
MS
03159265
1164685640
SANDHU, NAVEEN S MD
FLOWOOD
MS
00774027
1598907289
SANDHU, VARRINDER MD
TUPELO
MS
02133205
1811260540
SANDIDGE-PETERSON, MEGHAN E NP
STARKVILLE
MS
07434360
1639568934
SANDIFER JR, JULIAN NP
JACKSON
MS
07087501
1881873990
SANDIFER, JOHN D MD
JACKSON
MS
04526240
1831453158
SANDIFER, PHILLIP A MD
JACKSON
MS
08021801
1104002898
SANDIFER, VANESSA L MD
JACKSON
MS
02989825
1033311980
SANDNESS, DORCAS J MD
GRENADA
MS
00233597
1144527292
SANDRIDGE, SHANDA W MSN
JACKSON
MS
00114992
1629042304
SANFORD JR, BENJAMIN F MD
STARKVILLE
MS
00117094
1649316233
SANFORD, DORIS P FNP
LEXINGTON
MS
05826515
1700220969
SANFORD, ELIZABETH NP
COLUMBUS
MS
07429300
1255520458
SANFORD, KIMBERLY N MD
GREENWOOD
MS
09520566
1770885121
SANFORD, LISA M FNP-B
JACKSON
MS
00126253
1639230675
SANFORD, WILLIAM D
OXFORD
MS
00018318
1922102219
SANGANI, BHARAT H MD
GULFPORT
MS
03285044
1396199840
SANKOORIKAL, VINEETH-JOSEPH J MD
JACKSON
MS
09733215
1144413956
SANSING, BROCKTON J MD
TUPELO
MS
03501795
1104023399
SANTA TERESA, GRACE E MD
HAZLEHURST
MS
07902235
1033217898
SANTIAGO-FONT, JOSE A MD
JACKSON
MS
06384731
1407045230
SARB, MATTHEW L DO
GULFPORT
MS
03580348
1841642162
SARDAR, VARUN M MD
JACKSON
MS
274
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06334311
1780905273
SARKISSIAN, ARIN D MD
MERIDIAN
MS
09381574
1427159839
SARTIN, MARY K CFNP
JACKSON
MS
00010229
1184739401
SASLAWSKY, MARK J MD
SOUTHAVEN
MS
02959331
1942487525
SATHISH, MANJULA S MD
JACKSON
MS
03325093
1235244245
SATHYAMOORTHY, MADHANKUMAR MD
JACKSON
MS
05785861
1538460225
SATPUTE, SHAILESH R MD
NEW ALBANY
MS
01004021
1710176961
SATTERFIELD BYNUM, BRIDGET R CFNP
GREENVILLE
MS
00451879
1306126271
SAUCIER, BONNY A NP
JACKSON
MS
00122903
1003849068
SAUL, CHAD MD
LAUREL
MS
05682595
1598050908
SAUL, EMILY B DO
JACKSON
MS
01531540
1295022861
SAUL, KENNETH D MD
JACKSON
MS
06272354
1538140108
SAULNY, STANLEY M MD
HATTIESBURG
MS
05507362
1679882385
SAULTER, FELECIA M
JACKSON
MS
00126372
1659443711
SAULTERS, ROBERT L MD
JACKSON
MS
00123335
1457491383
SAUNDER, JAGWANI MD
JACKSON
MS
03556217
1417104167
SAUNDERS, BARBARA S DO
JACKSON
MS
01059562
1861468282
SAUS, JOHN A MD
JACKSON
MS
02650798
1194861138
SAVAL, APRIL PA
TUPELO
MS
02981061
1235144791
SAVICH, RENATE D MD
JACKSON
MS
00123192
1114955101
SAWARDECKER, SANDIP U MD
JACKSON
MS
02208220
1598818437
SAWAYA, DAVID E MD
JACKSON
MS
00019389
1184708067
SAWYER, DAVID N MD
GULFPORT
MS
08386702
1366989253
SAYLOR, ANNA NP
BILOXI
MS
00124144
1316053846
SAYLOR, BRUCE V MD
BAY ST LOUIS
MS
01127830
1518231067
SAYLORS, SHARLA ANP
ABERDEEN
MS
09858560
1356330955
SCALISE III, PETER P MD
MERIDIAN
MS
08274763
1487951042
SCALLIONS, JOHN NP
SOUTHAVEN
MS
00115521
1699702522
SCALZO, DAVID
JACKSON
MS
275
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00120348
1356440234
SCANLON, JR., PATRICK H MD
JACKSON
MS
00121446
1972698447
SCARBOROUGH, MELL ANN FNP
FLORENCE
MS
00060420
1508966375
SCARBROUGH, ARTHUR R DMD
RICHTON
MS
04357211
1992105191
SCARBROUGH, JAMI NP
PASCAGOULA
MS
02839393
1053577304
SCARBROUGH, MARIA A MD
WHITFIELD
MS
06037296
1184810012
SCARFF, TIFFANY A MD
WHITFIELD
MS
06123316
1710260401
SCHAEFER, ASHLEY B FNP
MERIDIAN
MS
06389899
1154535375
SCHAEFER, MARY A DO
MERIDIAN
MS
00118823
1912937574
SCHAEFFER, ALAN R MD
SOUTHAVEN
MS
02700531
1548364847
SCHAEFFER, PHILIP A
GULFPORT
MS
03838227
1891900122
SCHAFFARZICK, WILLIAM K DDS
GREENVILLE
MS
08286064
1679809230
SCHALLHEIM, JASON M MD
JACKSON
MS
05329758
1114158938
SCHARR, NERMA B MD
OLIVE BRANCH
MS
03200278
1972967792
SCHAUB, JOHN R DO
JACKSON
MS
05082238
1245263995
SCHEER, THOMAS F MD
NATCHEZ
MS
02204724
1962430322
SCHELL, LISA G CNNP
JACKSON
MS
00122579
1255446027
SCHEPENS, AMY T MD
GULFPORT
MS
00121762
1982719779
SCHEPENS, STEVEN M MD
GULFPORT
MS
04628272
1477563104
SCHIEFER, AMANDA J MD
JACKSON
MS
00155240
1417957218
SCHILLINGER, DAVID S MD
COLUMBUS
MS
02975334
1760601967
SCHLAGEL, KIMBERLY L
JACKSON
MS
02406066
1093815565
SCHLAKMAN, BRUCE MD
JACKSON
MS
00112908
1154359750
SCHLESSINGER, SHIRLEY
JACKSON
MS
00119947
1619905916
SCHMIDT, ANTHONY L MD
JACKSON
MS
00502516
1467747949
SCHMIDT, ERIC J MD
OCEAN SPRING
MS
00400741
1184922858
SCHMITZ, ALISON K NNP
JACKSON
MS
00124122
1326067083
SCHNEGG, JOANN K DO
MCCOMB
MS
03126301
1922254531
SCHNEIDER, GARY M MD
JACKSON
MS
276
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00119713
1063521607
SCHNEIDER-REDDEN, PETRA R MD
HATTIESBURG
MS
09782845
1518037662
SCHNUERER, SUSAN C APN
TUPELO
MS
08328295
1326109901
SCHOUEST, FREDERICK MD
BAY SAINT LOUIS
MS
07384513
1912015298
SCHRADER, CAROLYN A
LAUREL
MS
07405344
1700841624
SCHROADER, DARYL G MD
TUPELO
MS
02902058
1497194120
SCHROEDER, ELIZABETH L NP
JACKSON
MS
09132725
1043541337
SCHUETZ-SMITH, CYNTHIA M NP
MCCOMB
MS
00125196
1447282165
SCHWAGER, KEITH T MD
NATCHEZ
MS
03409061
1750510962
SCHWANEBECK, JASON R MD
FLOWOOD
MS
00122358
1184760910
SCHWARTZ, ALAN C MD
POPLARVILLE
MS
07321201
1932201613
SCHWARTZ, JAY H MD
CLEVELAND
MS
00110553
1518990266
SCHWARTZ, ROBIN H
HATTIESBURG
MS
00124305
1780793331
SCHWARTZ, RONALD L MD
HATTIESBURG
MS
00880121
1912951187
SCHWARZ, DAVID P OD
PICAYUNE
MS
09636381
1710958202
SCHWEINFURTH, JOHN
JACKSON
MS
02136590
1558772558
SCOGGIN, DARREN T MD
JACKSON
MS
00114206
1316980097
SCOGGIN, DONALD T NP
ELLISVILLE
MS
02505546
1164778056
SCORTEGAGNA, EDUARDO MD
JACKSON
MS
05574232
1861833477
SCOTT JR, THOMAS V FNPBC
RULEVILLE
MS
00657000
1164633202
SCOTT, ANDREA T MD
SOUTHAVEN
MS
07088805
1497802581
SCOTT, COLETTE M MD
BRANDON
MS
08201774
1205881489
SCOTT, HEATH E MD
YAZOO CITY
MS
05457590
1700118882
SCOTT, JENNIFER L FNPBC
LELAND
MS
00012401
1083714612
SCOTT, JONETTE S
GULFPORT
MS
09407209
1801258918
SCOTT, KATIE R MD
JACKSON
MS
00125774
1306827597
SCOTT, KERRY M DO
CHOCTAW
MS
00125322
1275535551
SCOTT, MICHAEL S DO
NEW ALBANY
MS
01156759
1073963187
SCOTT, OKSHOON NP
MADISON
MS
277
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04706066
1790751469
SCOTT, RONALD B
NEW ALBANY
MS
00087881
1497783864
SCOTT, SALLYE S OD
SARDIS
MS
00113503
1093828683
SCOTT, SETH A MD
LUCEDALE
MS
00125879
1336183136
SCOTT-BENNETT, CHARLETTA L MD
SOUTHAVEN
MS
00117436
1164521548
SCRUGGS, SHARON
PURVIS
MS
00116431
1861423766
SCURRIA, PHILIP L MD
VICKSBURG
MS
08401803
1487094801
SEABORN, JESSICA M MD
JACKSON
MS
01436739
1316089634
SEAGO, DAVID E DMD
FLOWOOD
MS
00036593
1700911096
SEAGO, DONALD L DDS
JACKSON
MS
00118260
1952473084
SEAGO, GINA B CFNP
JACKSON
MS
00118110
1164664348
SEAGO, KAREN R NP
PEARL
MS
00125893
1194717363
SEAGO, PAUL D MD
JACKSON
MS
00621784
1720129950
SEALE, BEN W MD
JACKSON
MS
03870374
1790135135
SEALE, DANIEL
HATTIESBURG
MS
03039077
1023113735
SEALE, JEFFREY K MD
MERIDIAN
MS
00112803
1780672808
SEAMAN, MARGARET E FNP
PLANTERSVILLE
MS
04887761
1730323213
SEARCEY, BRETT K MD
OCEAN SPRINGS
MS
00126874
1568564870
SEARCY, CARISSA I FNP
TREMONT
MS
00660081
1669586327
SEARD-HIGGINS, TARYON M
GREENVILLE
MS
09806704
1619164019
SEAWRIGHT, ASHLEY H NP
JACKSON
MS
00118408
1306955950
SECREST, BRADLEY N MD
HATTIESBURG
MS
04380029
1699717249
SEELEY, SAMUEL D FNP
RULEVILLE
MS
09956264
1609163880
SEELY, III, WILLIAM E MD
JACKSON
MS
02483041
1831244540
SEGARRA, JAY T MD
GULFPORT
MS
00013060
1609871607
SEGARS JR, KELLY S MD
IUKA
MS
00120678
1326081092
SEGLIO, THOMAS J DO
PICAYUNE
MS
00016082
1598855546
SEGREST, DAVID R MD
JACKSON
MS
01124399
1124275862
SEGREST, LAURA L NP
MERIDIAN
MS
278
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118219
1093760175
SEIBEL, JOHN E MD
GRENADA
MS
00005217
1285663799
SEICSHNAYDRE, MICHAEL A MD
GULFPORT
MS
00120374
1760410245
SEID, KELLY
CHOCTAW
MS
04078078
1508876772
SEIGERMAN, JEDD A MD
GULFPORT
MS
04130550
1134180615
SEIGLER, RICHARD A MD
TUPELO
MS
06571037
1629349931
SELLERS HOLLOWAY, LUCY W CFNP
BROOKHAVEN
MS
02628230
1659635027
SELLERS, AMANDA D DO
HATTIESBURG
MS
02605836
1821350539
SELVARAJ, NEMALAN DO
CORINTH
MS
09976791
1053545913
SELVARAJ, PRADEEP K MD
WOODVILLE
MS
00880320
1770558454
SENCHENKOV, ALEX MD
JACKSON
MS
09826251
1265521710
SENDRA, FIDEL F MD
HATTIESBURG
MS
00120613
1295805190
SENF II, WILLIAM L MD
CORINTH
MS
05808060
1689055956
SENITKO, CHELSEA E FNP
BRANDON
MS
02458758
1396952271
SENITKO, MARTIN MD
PASCAGOULA
MS
03807518
1336378637
SENITKO, MICHAL MD
JACKSON
MS
00115312
1558343392
SENTER, STEPHEN K MD
BELMONT
MS
00010860
1487811311
SENTER, SUZANNE B MD
CORINTH
MS
07283522
1336184407
SERIO, NAHUM V DO
TUPELO
MS
02729068
1992800916
SESERA, RUTH S NP
PASCAGOULA
MS
00337052
1295042919
SESSER, EMILY M NP
COLUMBUS
MS
07058569
1053622670
SESSUMS, JOEY K DMD
BROOKHAVEN
MS
00115588
1316054976
SESSUMS, JOEY K MD
BROOKHAVEN
MS
00017797
1972576460
SESSUMS, MARION C
HATTIESBURG
MS
00235069
1316046410
SETHI, MANISHA MD
RIDGELAND
MS
04730242
1619142718
SETTIPALLI, RAMAKRISHNA R MD
GULFPORT
MS
02509396
1033531942
SETTLEMIRES, SHELIA G FNP-C
RIPLEY
MS
03676063
1528259785
SETZER, JOHN OD
MADISON
MS
05670371
1457612194
SEWARD, CHRISTOPHER J MD
JACKSON
MS
279
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06058723
1982772703
SEXTON, JENNIFER A MD
OCEAN SPRINGS
MS
06189002
1992719181
SEXTON, ROBERT G MD
CORINTH
MS
03377260
1356607857
SEXTON, TYLER D MD
PASCAGOULA
MS
03087004
1265708002
SEYMOUR, CANDANCE R FNP
TYLERTOWN
MS
00121603
1033260625
SEYMOUR, JR, MICHAEL M
PASCAGOULA
MS
09107765
1154712248
SEYMOUR, KELSY P NP
GULFPORT
MS
07089874
1972709228
SEYMOUR, TIMOTHY H MD
MERIDIAN
MS
07576018
1073916771
SHABAZZ, JEANETTE NP
OCEAN SPRINGS
MS
00087049
1558499640
SHACKELFORD, RAYMOND C OD
HERNANDO
MS
06954074
1558386698
SHAFER, KILEY P MD
MERIDIAN
MS
00880229
1679611446
SHAFFER, CURTIS J OD
HATTIESBURG
MS
03707254
1215252341
SHAFFER, WILLIAM MD
PICAYUNE
MS
00188398
1679684872
SHAH, BASIL MD
GULFPORT
MS
06082501
1447566740
SHAH, DEEPAL J MD
JACKSON
MS
03806761
1316387731
SHAH, HINA P MD
JACKSON
MS
00931760
1225224157
SHAH, JINAL M.D.
FLOWOOD
MS
09779765
1538351986
SHAH, KUMAR MD
COLUMBIA
MS
00123304
1306956297
SHAH, MANOJ P MD
GULFPORT
MS
09651555
1235495474
SHAH, NIRAJ J MD
JACKSON
MS
01739283
1255391728
SHAHSHAHAN, ALI MD
HATTIESBURG
MS
03755754
1790958114
SHAIJU, ANEESHA MD
SENATOBIA
MS
02358242
1215967500
SHAKE, JAY G MD
JASCKON
MS
09135825
1073878237
SHAKEEL, NAZNEEN MD
JACKSON
MS
00125087
1396712915
SHAKIR, SHAMA
BAY SAINT LOUIS
MS
05487537
1659559300
SHAKTI, DIVYA MD
JACKSON
MS
08109560
1891863502
SHAMBURGER, SUSAN E MD
JACKSON
MS
05155318
1811954134
SHAMMAS, CARLOS R MD
SOUTHAVEN
MS
00117009
1346247798
SHANDS, THOMAS A MD
NEW ALBANY
MS
280
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00586821
1477518793
SHANN, TIMOTHY R MD
BROOKHAVEN
MS
05307227
1407067739
SHANNON, ANGELA B MD
FLOWOOD
MS
00017722
1306819891
SHANNON, EUGENE L M.D.
HATTIESBURG
MS
00508243
1043327034
SHANNON, MARISA D FNP
OCEAN SPRINGS
MS
07770077
1851562342
SHANNON, PAUL J MD
GULFPORT
MS
00014746
1730165937
SHAPIRO, MARVIN L
OLIVE BRANCH
MS
00117508
1083723639
SHAPIRO, STEVEN MD
LAUREL
MS
07176395
1659552677
SHAPLEY JR, CHRISTOPHER A
STARKVILLE
MS
00880143
1003034380
SHAPPLEY JR, ROBERT W OD
CORINTH
MS
00014308
1164446522
SHAPPLEY, III, NATHAN P MD
HATTIESBURG
MS
00118511
1093715641
SHARMA, ACHIN MD
HORN LAKE
MS
02822875
1801143995
SHARMA, RAJESH K MD
JACKSON
MS
02224776
1780849430
SHARP, CHRISTOPHER D MD
SOUTHAVEN
MS
09026854
1184938201
SHARP, OCTAVIAN NP
SOUTHAVEN
MS
09651252
1871740910
SHARP, PATRICIA J MSN
JACKSON
MS
03601094
1295019651
SHARP, SAMUEL A FNP
JACKSON
MS
05321091
1174075329
SHARP, VERONICA D PA-C
BILOXI
MS
09778741
1235154121
SHATLEY, MIRIAM J MD
FLOWOOD
MS
00124507
1962594481
SHAVERS, TONGII MD
GULFPORT
MS
02152737
1073905923
SHAW, BRITTANY NP
DIAMONDHEAD
MS
04221545
1457508475
SHAW, JILL FNP
CHOCTAW
MS
04776258
1235115056
SHAW, MICHAEL D MD
STARKVILLE
MS
01228391
1073058020
SHAW, MICHAEL G PMHNP
WHITFIELD
MS
05109843
1790077691
SHAW, TORIA M FNP-C
BATESVILLE
MS
00123160
1396786752
SHAW, VIRGINIA N NP
COLUMBUS
MS
03022056
1598030595
SHAW, WENDY L CNM
GULFPORT
MS
09322335
1588662720
SHEEHAN, CLYDE A MD
TUPELO
MS
03106560
1376549816
SHEEHAN, JOHN J MD
MERIDIAN
MS
281
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09855521
1518178524
SHEEHAN, NATALE T MD
JACKSON
MS
00126023
1104895028
SHEELY, ROBERT A MD
CLINTON
MS
00121047
1558536037
SHEFFIELD, KIMBERLY
FLOWOOD
MS
00113398
1093783672
SHEFFIELD, PAUL E MD
JACKSON
MS
08488768
1295845832
SHEFFIELD, SUSAN F FNP
TUPELO
MS
01239229
1114215456
SHEGOG, MIRANDA M FNP
MOUND BAYOU
MS
04374307
1356781629
SHEKHAR, SHASHANK MD
JACKSON
MS
04703706
1265653372
SHEKHAWAT, NAWAL S MD
TUTWILER
MS
00115572
1841347770
SHEKONI, NURUDEEN A MD
JACKSON
MS
09338201
1851333009
SHELBY, CHRISTOPHER L MD
BILOXI
MS
06276506
1023224250
SHELL, DAN H MD
OXFORD
MS
09237260
1891953642
SHELLIE V BRELAND DDS PLLC
PELAHATCHIE
MS
09237260
1891953642
SHELLIE V BRELAND DDS PLLC
RIDGELAND
MS
08239510
1750422713
SHELTON, BETH A DMD
TUPELO
MS
00120902
1659445492
SHELTON, BRENDA CFNP
RIPLEY
MS
08656863
1083004022
SHELTON, CHRISTINA G NP
TUPELO
MS
05505096
1427375716
SHELTON, DEANNA N NP
OLIVE BRANCH
MS
00122700
1104811652
SHELTON, VIRGINIA NP
FLOWOOD
MS
00115768
1578551792
SHELTON, WALTER R MD
JACKSON
MS
01705861
1982784468
SHENOY, VEENA MD
VICKSBURG
MS
05086719
1699701060
SHENOY, VISHWANATH MD
FLOWOOD
MS
02179873
1033563580
SHEPARD, AMBER Y MD
JACKSON
MS
03728242
1881638666
SHEPHERD, AMY B MD
CLINTON
MS
08626011
1346680782
SHEPHERD, BENJAMIN D MD
JACKSON
MS
07426041
1548614290
SHEPHERD, BRANDON A MD
JACKSON
MS
00118336
1497789879
SHEPHERD, JINNA M MD
JACKSON
MS
00116650
1760499867
SHEPHERD, MARK D MD
TUPELO
MS
00062430
1295813210
SHEPHERD, THOMAS MD
ABERDEEN
MS
282
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06356838
1649280983
SHEPPARD, JERRY M MD
JACKSON
MS
00001208
1417002965
SHERMAN, HENRY L MD
SOUTHAVEN
MS
00019503
1215928122
SHERMAN, ROSS K
WAYNESBORO
MS
00120838
1619910478
SHERMER, CHESTER D MD
JACKSON
MS
00114489
1942212543
SHERROD, CLIDE S MD
MERIDIAN
MS
00018747
1043395239
SHERWOOD, JULIA K MD
JACKSON
MS
00880040
1427180553
SHERYL W LEE OD LLC
BROOKHAVEN
MS
00936361
1558565267
SHETH, MICHELLE M MD
JACKSON
MS
09728755
1548586399
SHIAO, RENEE T MD
PASCAGOULA
MS
00118146
1023074101
SHIELDS, JOHN G MD
WEST POINT
MS
09370239
1639373012
SHIFLETT, AMBER N MD
JACKSON
MS
00573859
1366601593
SHIFLETT, JAMES M MD
JACKSON
MS
07722536
1821041336
SHILOAH, SHIRA MD
OLIVE BRANCH
MS
00119514
1851373500
SHINE, KATHLEEN T
MERIDIAN
MS
06435092
1699937680
SHIPLEY, SONYA R MD
BROOKHAVEN
MS
02909231
1225044001
SHIPP V, ROBERT S OD
GREENVILLE
MS
00015611
1457379398
SHIPP, BERNARD L MD
CORINTH
MS
03770551
1427212992
SHIPP, JAMES B MD
OXFORD
MS
06484070
1508871195
SHIPP, JASMINE D OD
CLEVELAND
MS
03021265
1538379789
SHIPP, JOHN R MD
CORINTH
MS
05408509
1063724987
SHIPP, LYNDSAY R MD
OXFORD
MS
05456030
1285016279
SHIPP, MAGAN L CNP
BATESVILLE
MS
00113620
1144232109
SHIRLEY, DEBORAH A MD
STARKVILLE
MS
06377539
1861739922
SHIRLEY, GEORGIA C CNP
JACKSON
MS
00018005
1720044456
SHIRLEY, STEPHEN M
NEW ALBANY
MS
00686208
1821287061
SHIVANANDA, MADHU N MD
JACKSON
MS
04275896
1184958753
SHIVERS, ASHLEY M MSN
BRANDON
MS
03706843
1942471115
SHIVERS, JAMES H FNP
COLLINS
MS
283
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09983301
1083942338
SHIVES, JASON L MD
HATTIESBURG
MS
07587317
1346291580
SHLEWEET, JOSEPH K DDS
CLARKSDALE
MS
07700067
1548255409
SHOAF, GUY M MD
OXFORD
MS
00119033
1477662229
SHOCKLEY, BRIAN E
VICKSBURG
MS
08453541
1043673833
SHOCKLEY, JAMES M MD
JACKSON
MS
06489555
1508125576
SHOEMAKE, KELLY N MD
ELLISVILLE
MS
00486404
1629403704
SHOEMAKER, COREY L NP
FOREST
MS
09785526
1043582513
SHOOK, GINGER A NP
CORINTH
MS
08709031
1205155967
SHOOK, JANICE MD
JACKSON
MS
04878346
1881703445
SHOOK, JONATHAN W MD
HATTIESBURG
MS
01338854
1629288626
SHOOK, SUSANNAH M DMD
HATTIESBURG
MS
00119492
1598700577
SHOOP, STEPHEN B DO
WHITFIELD
MS
00123172
1568493450
SHORES, JENNIFER C
JACKSON
MS
06429576
1447690854
SHORES, JOEL MD
LAUREL
MS
05336540
1730543547
SHORT, DAVID H MD
JACKSON
MS
05487222
1710227848
SHOULTZ, RUSSELL T NP
CARRIERE
MS
09889291
1609082064
SHOWALTER, JOHN W MD
JACKSON
MS
06030056
1558696799
SHOWALTER, KATIE E PA
OCEAN SPRINGS
MS
06772317
1942268529
SHOWKAT, ARIF MD
OLIVE BRANCH
MS
00124485
1871575373
SHOWS, DARELL E PA
MERIDIAN
MS
07805026
1275824088
SHOWS, KIMBERLY R ACNP
HATTIESBURG
MS
00122296
1902815566
SHOWS, ROBERT M M.D.
BYRAM
MS
00122308
1326121542
SHPARAGO, NEAL I DO
JACKSON
MS
05157853
1922040161
SHRADER, MICHAEL W MD
JACKSON
MS
00121530
1285715938
SHRESTHA, SANJIB D MD
MADISON
MS
00011270
1497843676
SHROCK JR, WIRT F MD
DURANT
MS
00113242
1578545968
SHROCK, MICHAEL B
PHILADELPHIA
MS
09151346
1447488028
SHROFF, MILONI MD
BILOXI
MS
284
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08537064
1912210725
SHUKLA, SHILPA MD
ELLISVILLE
MS
00672357
1376871160
SHULL, GRETCHEN S MSN
JACKSON
MS
00116633
1912901513
SHUMAKER, GRACE G
JACKSON
MS
00113911
1376587956
SHUMAKER, TIMOTHY MD
WHITFIELD
MS
00014607
1487633830
SHUMSKI, EDWARD J
BILOXI
MS
03355793
1487949087
SHUTT, JENNY Y DMD
SENATOBIA
MS
06557294
1972521151
SHWAYDER, JAMES M MD
JACKSON
MS
00119449
1588667414
SHWER, BRIAN I
SOUTHAVEN
MS
05035791
1801089347
SI, XIAOHONG MD
BRANDON
MS
00113701
1609896703
SICARD, DAVID L MD
HATTIESBURG
MS
07372301
1235380593
SIDDIQUE, AFSHEEN MD
OCEAN SPRINGS
MS
00116027
1255313896
SIDDIQUI, AKHTAR MD
MERIDIAN
MS
00115165
1972549251
SIDDIQUI, OBAID A MD
OCEAN SPRINGS
MS
00016777
1447268347
SIDHU, DESH D MD
SENATOBIA
MS
00120361
1184796203
SIDHU, SAVIRA V MD
SOUTHAVEN
MS
07679760
1760741789
SIEGEL, DAVID R MD
JACKSON
MS
00113210
1922118173
SIERRA, FRANCISCO J MD
TUPELO
MS
02084721
1497835847
SIEW, DARRICK MD
WAYNESBORO
MS
09822823
1548607120
SIFFRARD, JANITA A DDS
OLIVE BRANCH
MS
08654521
1679734727
SIFFRARD, VENIS F DDS
OLIVE BRANCH
MS
00115324
1477584308
SIGURNJAK, KATHRYN L MD
BILOXI
MS
00288841
1861623688
SIJANSKY, KEVIN L MD
FLOWOOD
MS
08883274
1366438244
SIJIN, ODALIS MD
VICKSBURG
MS
00119853
1225067127
SIKES, JAMES N MD
HATTIESBURG
MS
01773870
1962790709
SIKES, KRISTINA J DO
CLARKSDALE
MS
00629072
1982934311
SILVER, KEVIN DO
TUPELO
MS
04051062
1780824714
SILVER, SARA A DO
JACKSON
MS
00052551
1457652620
SILVIO, DANIEL J PA
VICKSBURG
MS
285
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08120097
1851482855
SIMEONE, FRANCESCO MD
BILOXI
MS
00706872
1508113606
SIMEUNOVIC, KOSANA MD
HATTIESBURG
MS
06131738
1992766943
SIMMONS JR, EUGENE A MD
BROOKHAVEN
MS
09683890
1831523620
SIMMONS, ALYSSA K NP
INDIANOLA
MS
02903022
1114325982
SIMMONS, APRIL R MSN
JACKSON
MS
06805077
1609321702
SIMMONS, ASHLEY N NP
CHOCTAW
MS
06939044
1134667843
SIMMONS, BONNEY N NP
JACKSON
MS
02678830
1861412975
SIMMONS, DANIEL R DMD
SOUTHAVEN
MS
00116294
1285620633
SIMMONS, DEBRA A RNC
GRENADA
MS
00256807
1598751281
SIMMONS, EARNEST C MD
MERIDIAN
MS
07834351
1912372798
SIMMONS, JULIE J NP
GULFPORT
MS
00880215
1104937556
SIMMONS, NEIL H OD
CARTHAGE
MS
01572033
1548271448
SIMMONS, RYAN C M.D.
TUPELO
MS
03400807
1972867158
SIMMONS, SHANEKA L NP
JACKSON
MS
00064894
1184064321
SIMMONS, VAN R DMD
MCCOMB
MS
00117044
1568428647
SIMMONS, WINNIE S
MABEN
MS
00113836
1851400410
SIMNICHT, KEITH M MD
PETAL
MS
00116081
1134220742
SIMNICHT, KIM T CFNP
HATTIESBURG
MS
07889364
1861871949
SIMON, ASHLEY S MD
JACKSON
MS
00126003
1174603096
SIMON, URELAINE R
MERIDIAN
MS
04650361
1528249554
SIMPLER, JEREMY J MD
PASCAGOULA
MS
04383027
1164728085
SIMPSON, CASSY S DMD
NATCHEZ
MS
00112198
1245259969
SIMPSON, DON E
CORINTH
MS
02089530
1831468305
SIMPSON, JACKIE D FNPC
JACKSON
MS
07771546
1407978752
SIMPSON, JOSHUA L DMD
MCCOMB
MS
04070596
1407167547
SIMPSON, LAUREN S MD
NEW ALBANY
MS
02305708
1811367048
SIMPSON, PATRICIA CNP
SHUBUTA
MS
03120221
1134323538
SIMPSON, REGENA A CFNP
BILOXI
MS
286
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04329316
1255338349
SIMPSON, SAMUEL L MD
GULFPORT
MS
06988867
1376705699
SIMPSON, SCOTT A MD
JACKSON
MS
00064987
1740476084
SIMPSON, WILLIAM D DMD
OKOLONA
MS
05830006
1851774681
SIMS, ELIZABETH M FNP
MERIDIAN
MS
00250771
1952727315
SIMS, HILLARY B MD
JACKSON
MS
03159001
1073995098
SIMS, JALEEN D MD
JACKSON
MS
00335014
1538344585
SIMS, SHANE M MD
FLOWOOD
MS
04583552
1043490246
SIMS, TAMMY L MD
CLINTON
MS
03200051
1124441571
SIMS, TERESA M CFNP
WEST POINT
MS
04737777
1750830378
SIMS-PERRY, REBECCA L FNP
BRANDON
MS
02102515
1235391046
SINCLAIR, DAVID J MD
JACKSON
MS
08453741
1891148011
SINCLAIR, JESSICA C NP-C
FLOWOOD
MS
06382033
1497197859
SINGH, AMANDEEP MD
JACKSON
MS
07685053
1326257510
SINGH, BARINDER P BDS
JACKSON
MS
07823011
1548460454
SINGH, HARPAL MD
MENDENHALL
MS
00016697
1356310536
SINGH, JATINDER MD
WAYNESBORO
MS
07331736
1245499953
SINGH, JATINDER P MD
PASCAGOULA
MS
05828295
1295770709
SINGH, SATWINDER MD
GREENVILLE
MS
00660412
1659464741
SINGLETARY, ALBERT J
CRYSTAL SPRINGS
MS
03858212
1407917453
SINGLETARY, MOLLY S MD
OXFORD
MS
05638867
1134210693
SINGLETON, CAROLE-LYNNE W
INDIANOLA
MS
03086061
1417311630
SINGLETON, TAKENYA A NP
RIDGELAND
MS
02328252
1760464309
SINGLEY, BRIGGETTE J FNP
MERIDIAN
MS
00118307
1235187816
SINOJIA, GIRISH V MD
RIPLEY
MS
00125761
1306866249
SINOPOLI JR, GARY J
OCEAN SPRINGS
MS
00458263
1831140557
SIRAGUSA, ROBERT J MD
BILOXI
MS
06479201
1457489429
SISK, JAMIE D MD
LAUREL
MS
03176704
1275945271
SISODRAKER, TRISHNA MD
OCEAN SPRINGS
MS
287
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02578221
1992983829
SISSON, CHASITY M FNP
HEIDELBERG
MS
05076811
1396030201
SISSON, FALON R FNP
GULFPORT
MS
00124713
1164430419
SISTRUNK, JOHN W MD
JACKSON
MS
00114414
1609885284
SIVILS, LARRY W M.D.
MADISON
MS
06854309
1871562231
SKAF, RANA A MD
JACKSON
MS
00878825
1790925758
SKAGGS, ASHLEY E NP
BAY ST LOUIS
MS
06974886
1467688986
SKAGGS, JUDY P
HATTIESBURG
MS
09485272
1467487488
SKARL, SHERIDAN L CNM
GULFPORT
MS
03755729
1346460367
SKELTON, BRANDON W MD
TUPELO
MS
00017889
1164442349
SKELTON, THOMAS N
JACKSON
MS
07335792
1598867350
SKELTON, TIMOTHY B MD
BILOXI
MS
01521000
1225220239
SKINNER, ANGELA K NP
PHILADELPHIA
MS
03077383
1841575933
SKINNER, PEYTON L FNP
LAUREL
MS
00016905
1740290964
SKIWSKI, JACOB MD
COLUMBUS
MS
00122232
1992715130
SKIWSKI, JASON J MD
CLARKSDALE
MS
00239247
1003840232
SLACK, KRISTI M NP
MARIETTA
MS
08700008
1013080027
SLADE, LISA D CFNP
HATTIESBURG
MS
04538376
1811244593
SLADE, MEGAN E CFNP
WHITFIELD
MS
03428252
1760796148
SLAWSON, LISA N ACNP
OCEAN SPRINGS
MS
04329816
1982868782
SLEDGE, JONATHAN MD
WEST POINT
MS
04150266
1003114257
SLEDGE, RACHEL FNP
OXFORD
MS
00120912
1811928005
SLIGH, THOMAS K MD
VICKSBURG
MS
03954702
1790724276
SLOAN, JEFFREY B MD
GULFPORT
MS
05176568
1073522348
SLOAN, NEIL B MD
CORINTH
MS
00118169
1073527941
SLOBODNIK, ZDENKO MD
JACKSON
MS
03580821
1316172794
SLOCUM, RACHEL A NP
GULFPORT
MS
00115201
1083685242
SLOCUM, WAYNE A
TUPELO
MS
00010853
1235122268
SLONAKER, CHARLES E MD
GULFPORT
MS
288
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00660036
1801128129
SLOVER, RUSSELL H DMD
MAGEE
MS
04073558
1629301106
SLUDER, VANESSA K FNP
HERNADO
MS
00013539
1831127422
SLUIS, GORDON W MD
VICKSBURG
MS
08233075
1467908053
SMALLEY, ZACHARY S MD
JACKSON
MS
09978011
1881892552
SMASH, KIMBERLY MDP
JACKSON
MS
07629258
1134368939
SMELLEY, CHRISTOPHER L DO
PASCAGOULA
MS
03101732
1114021359
SMITH III, JOHN D CRNP
GULFPORT
MS
03576722
1184685158
SMITH III, RUSSEL N MD
NATCHEZ
MS
00660161
1073665691
SMITH JR, DON E DMD
KOSCIUSKO
MS
00064290
1104968395
SMITH JR, HUGH C DDS
CLEVELAND
MS
00064895
1487717880
SMITH JR, ROBERT L DDS
HERNANDO
MS
09455267
1659650166
SMITH, AARON J MD
JACKSON
MS
00124448
1578595203
SMITH, ADAM B
COLUMBUS
MS
07405247
1306163779
SMITH, ADAM R MD
JACKSON
MS
03757378
1578508735
SMITH, ADRIAN R MD
FLOWOOD
MS
00087025
1235213687
SMITH, ALAN C OD
SOUTHAVEN
MS
09203590
1699154625
SMITH, ALISHA J DO
JACKSON
MS
01083719
1396920971
SMITH, AMY G NP
JACKSON
MS
08336062
1730119223
SMITH, AMY M CFNP
BROOKHAVEN
MS
00016509
1841383619
SMITH, ANDREA L MD
CLARKSDALE
MS
08850801
1356301972
SMITH, ANDREW D MD
JACKSON
MS
09487534
1114301397
SMITH, ANDREW M MD
JACKSON
MS
05571009
1639335888
SMITH, ANDRIA L MD
PASCAGOULA
MS
00115690
1730187261
SMITH, BARBARA E MD
NATCHEZ
MS
00019109
1366422198
SMITH, BARBARA H MD
GREENWOOD
MS
06359772
1669783668
SMITH, BENJAMIN P MD
PASCAGOULA
MS
06375773
1316328461
SMITH, BRANDI A NP
JACKSON
MS
04509808
1841675436
SMITH, BRANDON K NP
LEAKESVILLE
MS
289
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02176325
1154522456
SMITH, BRIDGET MD
JACKSON
MS
00012871
1639253537
SMITH, CAROL A MD
DIAMONDHEAD
MS
03726577
1174714133
SMITH, CHAD P OD
BROOKHAVEN
MS
02208350
1700027786
SMITH, CHARLES B MD
PICAYUNE
MS
00120265
1578569687
SMITH, CHARLES M MD
SOUTHAVEN
MS
00280548
1306870662
SMITH, CLINTON R MD
VICKSBURG
MS
04938577
1679820799
SMITH, CYNTHIA H MSN
JACKSON
MS
03735792
1689858177
SMITH, DANIEL H MD
HATTIESBURG
MS
02285578
1396106456
SMITH, DAVID A PMHNP
BRANDON
MS
00125737
1023045572
SMITH, DAVID L
FLOWOOD
MS
00113837
1144310624
SMITH, DAVID P MD
SUMMIT
MS
00114163
1841228087
SMITH, DEBORAH MD
VICKSBURG
MS
06973856
1487636379
SMITH, DELIA A MD
JACKSON
MS
01301285
1245279918
SMITH, DENNIS E DO
TUPELO
MS
00062490
1457402299
SMITH, DON E DDS
KOSCIUSKO
MS
00013366
1386600427
SMITH, DONALD K DO
OKOLONA
MS
00660344
1326066481
SMITH, DUSTIN G DMD
COLUMBUS
MS
00880071
1104815992
SMITH, EMMETT D O.D.
CLEVELAND
MS
00870278
1659782670
SMITH, ERIN J MD
JACKSON
MS
07578792
1679891964
SMITH, EVELYN F FNP
CLEVELAND
MS
00111828
1659314185
SMITH, GARY L MD
WHITFIELD
MS
00018589
1316125735
SMITH, GEORGE V MD
GREENWOOD
MS
00119762
1619933744
SMITH, II, BOBBY H MD
PHILADELPHIA
MS
05207764
1740218528
SMITH, JAMES M MD
GREENVILLE
MS
07758808
1821027335
SMITH, JASON V MD
GULFPORT
MS
01380251
1104047331
SMITH, JEREMY T DO
HOUSTON
MS
07982360
1003278110
SMITH, JESTON T MD
JACKSON
MS
00064776
1306996970
SMITH, JOHN B DMD
JACKSON
MS
290
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07450209
1861756314
SMITH, JONATHAN E MD
JACKSON
MS
01528361
1659315042
SMITH, JUDITH W MD
BILOXI
MS
03825215
1215021001
SMITH, KATHERINE CFNP
WATER VALLEY
MS
00633792
1255572186
SMITH, KENNEDY E FNP
PASCAGOULA
MS
09858546
1568862019
SMITH, KIMBERLEY P NNP
FLOWOOD
MS
00660390
1649327164
SMITH, KIMBERLY B DMD
MENDENHALL
MS
05489015
1669733838
SMITH, KIMBERLY B FNP
SOUTHAVEN
MS
04801059
1841630076
SMITH, LEAH MD
JACKSON
MS
00880066
1629179791
SMITH, LEESA H OD
GREENVILLE
MS
02371779
1639192750
SMITH, LLOYD D MD
NATCHEZ
MS
08126544
1225323090
SMITH, LORA M FNP
HERNADO
MS
00631368
1457533424
SMITH, LORETTA J FNP
MARKS
MS
00125052
1275708737
SMITH, LURETHA NP
MADISON
MS
08703530
1982918421
SMITH, MANDI E OD
GULFPORT
MS
05237070
1992152284
SMITH, MARILYN NP
COLUMBUS
MS
00089225
1952497679
SMITH, MARK P OD
BROOKHAVEN
MS
00123462
1962451518
SMITH, MARY K MD
MAGEE
MS
02070024
1942256300
SMITH, MELISSA PMHNP
FLOWOOD
MS
04801821
1609156116
SMITH, MELISSA C FNP
HATTIESBURG
MS
00115203
1376531368
SMITH, MILTON S MD
MCCOMB
MS
05859866
1376858761
SMITH, MINDY J NP
JACKSON
MS
00116841
1275531881
SMITH, NORWOOD M MD
JACKSON
MS
00087835
1003917360
SMITH, OSCAR A OD
COLUMBIA
MS
05402200
1205065810
SMITH, PATRICK B MD
CLEVELAND
MS
05475760
1003909854
SMITH, PERCY L PA
CANTON
MS
00126719
1942206149
SMITH, PHILIP C
JACKSON
MS
05778869
1245456938
SMITH, RACHAEL E MD
SOUTHAVEN
MS
00117163
1740354992
SMITH, RALPH W MD
WHITFIELD
MS
291
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05774275
1760457980
SMITH, RANDALL S MD
JACKSON
MS
00118202
1639288293
SMITH, RANDEL L MD
HATTIESBURG
MS
00014345
1760422885
SMITH, RICHARD H
BILOXI
MS
04629211
1073526760
SMITH, RICHARD L DMD
MADISON
MS
00019424
1003981879
SMITH, ROBERT
WESTPOINT
MS
00011675
1285663591
SMITH, ROBERT
JACKSON
MS
09685357
1821250978
SMITH, ROBERT B MD
TUPELO
MS
00119567
1346235850
SMITH, RONALD B MD
OXFORD
MS
01779804
1043399876
SMITH, SAMUEL A MD
FLOWOOD
MS
00113621
1629057427
SMITH, SCOTT F MD
MCCOMB
MS
02955271
1427353283
SMITH, SELENA L NP
LAUREL
MS
01952365
1801287883
SMITH, SHANA FNP
CHARLESTON
MS
00125605
1861410458
SMITH, SHELLEY A
GRENADA
MS
05106090
1891884821
SMITH, STACY MD
SOUTHAVEN
MS
05277343
1003055005
SMITH, STEPHANIE D
LAUREL
MS
09034221
1174707368
SMITH, STEPHEN K MD
COLUMBUS
MS
05620843
1376804369
SMITH, STEVEN P MD
COLUMBUS
MS
00987326
1750566493
SMITH, SUMONA V MD
JACKSON
MS
09432255
1609067750
SMITH, TALETHA B MD
MERIDIAN
MS
00113839
1407968530
SMITH, TAMARA J FNP
TUPELO
MS
03886243
1033348438
SMITH, TAYLOR F MD
JACKSON
MS
03954555
1922310531
SMITH, TERESA D FNP
BATESVILLE
MS
00118612
1528219466
SMITH, TERRY C MD
BILOXI
MS
06873351
1235484296
SMITH, THOMAS B MD
JACKSON
MS
09434766
1013302082
SMITH, TIFFANY
JACKSON
MS
08088859
1013302082
SMITH, TIFFANY M PMHNP
JACKSON
MS
07832520
1245664531
SMITH, WALTER D MD
JACKSON
MS
08888048
1861595340
SMITH, WILLIAM H MD
MADISON
MS
292
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125989
1467476531
SMITH, WILLIAM T MD
STARKVILLE
MS
00116771
1093759722
SMITH, WILLIAM W MD
PASCAGOULA
MS
00016278
1114937463
SMITH-VANIZ, GEORGE T
JACKSON
MS
07275376
1114934643
SMITHERMAN, JAMES A MD
JACKSON
MS
02221749
1457507055
SMITHERMAN, JEREMY D MD
STARKVILLE
MS
03406818
1275566234
SMITHERS, STACY L MD
LAUREL
MS
00087892
1689742793
SMITHHART, R KIRK OD
JACKSON
MS
00660240
1760654560
SMITHIE, PAMELA S DMD
MCCOMB
MS
07250274
1851706477
SMOTHERS, LESLIE N
TUPELO
MS
00122914
1902938624
SMOTHERS, MARK
LEXINGTON
MS
08187014
1457647414
SMOYER, BRENT A
SOUTHAVEN
MS
06550800
1982689816
SMYTH, ANDREW T MD
JACKSON
MS
04477702
1992774798
SNEARLY, WILLIAM N MD
HATTIESBURG
MS
00117032
1639118300
SNEED JR, THOMAS A MD
OXFORD
MS
02901023
1073617775
SNEED, JIMMY D MD
SOUTHAVEN
MS
00115212
1861412553
SNEED, WILLIAM F MD
JACKSON
MS
08824840
1811150766
SNELL, DEIDRA J DMD
JACKSON
MS
00122562
1134236599
SNOW, DAVID S MD
MAGNOLIA
MS
00882542
1497152458
SNOW, DONNA CNP
CHOCTAW
MS
02853573
1053477711
SNOW, KIMBERLY L FNP
MAGNOLIA
MS
09387220
1700131331
SNYDER, ANNA R DMD
GULFPORT
MS
00116692
1508975178
SOBIESK, JOHN MD
HATTIESBURG
MS
07954751
1962411215
SOHAL, DAWINDER S MD
VICKSBURG
MS
00122628
1770699670
SOJOURNER, DENISE H MD
PONTOTOC
MS
05608381
1679881312
SOJOURNER, JENNIFER M FNP
CRYSTAL SPRINGS
MS
04800061
1386061778
SOLDEVILA, KATHERINE V NP
TUPELO
MS
06425712
1285661934
SOLOMON, NEIL J MD
HATTIESBURG
MS
03835222
1649320987
SOMBUTMAI, CHUT DO
TUPELO
MS
293
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00117446
1730129404
SOMJEE, ARIF A MD
ASHLAND
MS
04550047
1174813646
SONAIKE, VICTOR O MD
PICAYUNE
MS
00115717
1982692281
SONES II, JAMES Q MD
JACKSON
MS
01655363
1104218304
SONES, CHRISTOPHER L NP
COLUMBIA
MS
01573005
1447450010
SONES, WILLIAM D MD
BROOKHAVEN
MS
00015584
1689615486
SONGCHAROEN, SOMPRASONG MD
JACKSON
MS
07200539
1881815801
SONONE, RAHUL V
SOUTHAVEN
MS
04580003
1336398510
SOOD, HARPREET MD
COLLINS
MS
00880147
1245213081
SOREY, TINA R OD
JACKSON
MS
00111213
1639123078
SOREY, WILLIAM H MD
JACKSON
MS
00115409
1649348129
SORIANO, AUGUSTUS P M.D.
PHILADELPHIA
MS
00115495
1821107491
SORIANO, MARIA C
HATTIESBURG
MS
09258221
1669812004
SORREL, JONATHAN E MD
JACKSON
MS
00186219
1689609794
SORRELL, CATHERINE D MD
RIDGELAND
MS
00077331
1710922638
SORRELS, MARION J DO
FOREST
MS
08478237
1508881822
SOSA, JOSE A PA-C
JACKSON
MS
07721357
1891943692
SOSA, KELLY CFNP
BYRAM
MS
03827532
1639433725
SOTO INTERIANO, EDUARDO F MD
HATTIESBURG
MS
00113033
1790779858
SOTOLONGO, ROSE M DPM
RIDGELAND
MS
00018320
1588619621
SOUTH, DWALIA S MD
RIPLEY
MS
05989006
1649429481
SOUTH, TERESA M CFNP
IUKA
MS
00114061
1376506741
SOUTH, TIMOTHY M FNP
KOSCIUSKO
MS
01638815
1902800618
SOUTHALL, PAUL A MD
IUKA
MS
02127769
1134333255
SOUTHERN SURGICAL SERVICES
BROOKHAVEN
MS
00123102
1437120730
SOUTHWORTH, STEPHEN MD
TUPELO
MS
02750741
1518270164
SOUZA, ANA L MD
JACKSON
MS
06786849
1356587125
SOUZA, FREDERICO F MD
JACKSON
MS
06900713
1568508448
SOYINKA, OLUFEMI E MD
OLIVE BRANCH
MS
294
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00121278
1558465781
SPARACINO, MARIA G MD
CLEVELAND
MS
06756840
1922362300
SPARKMAN, BRIAN K MD
JACKSON
MS
02589533
1568584019
SPARKS, KENDRICK L MD
GULFPORT
MS
08781307
1265865992
SPARKS, WHITNEY NP
IUKA
MS
07659588
1083871206
SPATARO, MICHAEL T MD
GULFPORT
MS
07288575
1376965178
SPEAR, KRISTIAN NP
GULFPORT
MS
00113324
1538196845
SPEARS, JR, HUBERT E MD
OXFORD
MS
00119922
1548365901
SPEARS, MARVELL FNP
PORT GIBSON
MS
08870040
1659330090
SPECA, JOHN M MD
GRENADA
MS
00016239
1124031414
SPECK, JAMES W MD
ECRU
MS
00904389
1285997759
SPEED, JOAN C NP
MERIDIAN
MS
00114413
1144252834
SPEED, JULIUS K DO
TYLERTOWN
MS
02356022
1104868397
SPEEDLING, DIANE D MD
LAUREL
MS
03402331
1255743464
SPEIGHTS, JOHN R MD
TUPELO
MS
01080877
1548656614
SPEIGHTS, LASHUNDRA S FNP-C
LAUREL
MS
00121092
1790722999
SPEIGHTS, STEVEN E MD
JACKSON
MS
09030051
1689915944
SPELLS JONES, TONYA S ACNP
JACKSON
MS
07859339
1902076011
SPENCE, ADRIENNE N
PICAYUNE
MS
08508539
1104197508
SPENCE, REGAN D NP
JACKSON
MS
00014115
1013057645
SPENCE-EVANS, PAULA J MD
GREENWOOD
MS
05105778
1386842755
SPENCER JR, DAVID L MD
PASCAGOULA
MS
00087006
1568522746
SPENCER, BRIAN K OD
PASCAGOULA
MS
00115807
1053326348
SPENCER, DAVID L MD
PASCAGOULA
MS
07375342
1891119715
SPENCER, DEBORAH T CFNP
GULFPORT
MS
01427849
1508238791
SPENCER, LATASHA S AGNP
JACKSON
MS
04700722
1801837026
SPENCER, TERESA CFNP
JACKSON
MS
00380310
1053551283
SPICER, BEVERLY L ACNP
JACKSON
MS
03959531
1942641485
SPICER, JARED L DPM
OXFORD
MS
295
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04778509
1518167949
SPIERS, SANDRA J GNP
CARRIERE
MS
04155296
1134283542
SPINKS, AMY A DMD
LIBERTY
MS
01500549
1356518617
SPITLER, CLAY A MD
JACKSON
MS
02302313
1740377035
SPRABERY, A PATRICK MD
MERIDIAN
MS
06427823
1104036177
SPREAFICO, MARY E FNP
UNION
MS
00015095
1851457733
SPROLES, ARTHUR C
GULFPORT
MS
04984364
1013103415
SPRUILL, CYNTHIA D FNP
PRENTISS
MS
09829571
1467489930
SPURZEM, JOHN R MD
JACKSON
MS
08906878
1033521513
SREENIVASAN, VARUN MD
JACKSON
MS
05286267
1619945656
SRIVASTAVA, MOHIT MD
BAY SAINT LOUIS
MS
03651726
1598956641
SROUFE, RAMESES L MD
SOUTHAVEN
MS
02087274
1013370832
ST JOHN, JEFFREY G MD
JACKSON
MS
00110703
1508835349
STAATS-PUFFER, SUZANNE CNP
GULFPORT
MS
04934365
1851745251
STACHOWICZ, KATHERINE DO
JACKSON
MS
04226579
1154559961
STACY, JASON D MD
JACKSON
MS
05556228
1457320442
STADNICK, MICHAEL E MD
HATTIESBURG
MS
04079546
1649688912
STAFFORD, ELIZABETH A NP
GULFPORT
MS
05434893
1245567775
STAFFORD, KASSIE L PA
GULFPORT
MS
00116542
1043204654
STAGGS JR, KENNETH E M.D.
MERIDIAN
MS
00116623
1043314057
STALLWORTH, GREGORY T MD
HOLLY SPRINGS
MS
00112134
1629034764
STANBACK, JOHN E
COLUMBUS
MS
00015589
1114966785
STANCILL, HUGH W M.D.
LAUREL
MS
04185840
1063866705
STANFORD II, JAMES K MD
JACKSON
MS
00125675
1033220512
STANFORD, JAMES K MD
GRENADA
MS
00060036
1952313132
STANFORD, JOHN D DDS
RIPLEY
MS
08539218
1013972306
STANFORD, LOWRY C
HATTIESBURG
MS
00380215
1457796922
STANFORD, MONICA J NP
TUPELO
MS
03335347
1922237452
STANFORD, ONELLIS NP
BILOXI
MS
296
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
03354322
1679020630
STANFORD, REBECCA A NP
WEST POINT
MS
00121454
1396910865
STANFORD, STACEY RNC
JACKSON
MS
00121431
1245246099
STANFORD, TERESA P FNP
AMORY
MS
05579757
1356424576
STANICH, CHARLES A
PASCAGOULA
MS
00233368
1598052185
STANLEY, ANZA M MD
JACKSON
MS
00111937
1053625012
STANLEY, FRANKIE E MD
CORINTH
MS
03278374
1225238272
STANLEY, GREGORY A MD
JACKSON
MS
05838803
1770824955
STANLEY, KIMBERLY M FNP
MANTACHIE
MS
00112135
1417999301
STANLEY, MARKUS B DO
CLARKSDALE
MS
00639073
1952477168
STANTON, JENNIFER F CFNP
NEW ALBANY
MS
08634798
1639220205
STANTON, MAUREEN D NP
GULFPORT
MS
00424220
1740319839
STAPLES, CHRISTA CPNP
LAUREL
MS
08785327
1760719447
STARK, LEITA N CFNP
MANTACHIE
MS
00063220
1780705368
STARNES, DENNIS W DDS
MCCOMB
MS
00115313
1770550295
STARNES, EDDIE C MD
MERIDIAN
MS
09133813
1477633774
STARNES, ELIZABETH L NP
JACKSON
MS
00880072
1861598765
STASNEY, KRAIG M OD
PICAYUNE
MS
08887255
1366690950
STEADMAN, MARSHA N CFNP
CLEVELAND
MS
01637836
1649493560
STECKLER, DAVID R
RIDGELAND
MS
05451597
1821163692
STEED, SCOTT F
NATCHEZ
MS
07420504
1497060065
STEELE II, JOHN A DMD
CHOCTAW
MS
00013043
1588771455
STEELE, ALBERT W MD
JACKSON
MS
09721376
1407114747
STEELE, CHELSEA L MD
JACKSON
MS
01532554
1568843332
STEELE, JORDAN W DO
WAYNESBORO
MS
00126547
1972616779
STEELE, ROLLIE D MD
LUCEDALE
MS
08479210
1881083046
STEENKAMP, MELISSA D NP
GULFPORT
MS
02053709
1659325306
STEGALL, AVA L DO
STARKVILLE
MS
06781267
1699127027
STEGALL, JACINTA T FNP
TUPELO
MS
297
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07407534
1093260150
STEGALL, RACHAEL C FNP-B
FLOWOOD
MS
06330067
1518341072
STEGALL, STEPHANIE NP
TUPELO
MS
00114982
1245227073
STEIN, JOHNATHAN H MD
OXFORD
MS
07473818
1124226170
STEINER, MICHAEL A MD
JACKSON
MS
04137257
1245520881
STEINER, MURPHY M MD
SOUTHAVEN
MS
04272214
1497179063
STEINWINDER, SAMANTHA P NP
BILOXI
MS
02108579
1588983043
STEMPAK, LISA M MD
JACKSON
MS
00010424
1467479485
STENNETT, JERRY L MD
COLUMBUS
MS
05180817
1326248774
STEPHENS, JAMES W MD
MONTICELLO
MS
05234544
1043227713
STEPHENS, ROBBIE M
BRANDON
MS
00116194
1528130655
STEPHENS, WILLIAMS D MD
JACKSON
MS
00019980
1427188085
STEPHENSON, WILLIAM MD
JACKSON
MS
00660102
1184893711
STEPTOE, LASHAWN DDS
JACKSON
MS
00753269
1578720231
STERLING, ANGELA FNP
JACKSON
MS
03337587
1881757409
STERLING, KEVIN MD
TUPELO
MS
08384732
1609030139
STERLING, SARAH A MD
JACKSON
MS
01770838
1164459749
STERN, NEIL D DO
GRENADA
MS
07582356
1659377257
STEUER, MICHAEL E MD
SOUTHAVEN
MS
00124898
1427088814
STEVEN D MAJOR M D PLLC
SOUTHAVEN
MS
00119265
1336246446
STEVENS, CARL W MD
LAUREL
MS
00113842
1225007537
STEVENS, CLAUDINE S
GREENWOOD
MS
01700006
1215137096
STEVENS, DANIEL G DO
MENDENHELL
MS
09604063
1497016943
STEVENS, KESHA L MD
SENATOBIA
MS
00122272
1861501447
STEVENS, MARK A MD
COLUMBIA
MS
03177353
1447494570
STEVENS, MATTHEW S MD
TUPELO
MS
00121547
1124067368
STEVENS, THOMAS E MD
PASCAGOULA
MS
04703866
1649620261
STEVENSON, DANISHA L
HATTIESBURG
MS
07606526
1053486852
STEVENSON, NATALIA A
ELLISVILLE
MS
298
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00014186
1083776116
STEWARD, EDWARD A MD
BATESVILLE
MS
00116693
1730298324
STEWART, DEANNA K MD
HATTIESBURG
MS
01273368
1275936163
STEWART, GINGER L CFNP
SOUTHAVEN
MS
08602226
1043442254
STEWART, GWENDOLYN J FNP-B
VICKSBURG
MS
06350285
1972868628
STEWART, HANNAH S NP
STARKVILLE
MS
05721802
1184818213
STEWART, JAMES H MD
MADISON
MS
00402760
1598077034
STEWART, JAWAUNA MD
HATTIESBURG
MS
02322374
1053618355
STEWART, JENNIFER S FNP
HATTIESBURG
MS
06353795
1295026268
STEWART, JENNIFER T NP
PASS CHRISTIAN
MS
02259304
1336599489
STEWART, JEREMY D FNP
HATTIESBURG
MS
00121927
1497791784
STEWART, JIMMY
JACKSON
MS
06579705
1447220926
STEWART, JOHN S DO
STARKVILLE
MS
00117485
1639207541
STEWART, KERRY D MD
HATTIESBURG
MS
02925760
1790216091
STEWART, LAJOYCE FNP
KILMICHAEL
MS
03870528
1174855647
STEWART, LISA A MSN
JACKSON
MS
04689005
1902180979
STEWART, MARY GNP
BOLTON
MS
01880336
1689803918
STEWART, PATRICIA H MD
JACKSON
MS
00016041
1871680322
STEWART, REGINALD W MD
PASCAGOULA
MS
00120573
1932165073
STEWART, ROBERT N MD
TUPELO
MS
05750542
1740659960
STEWART, TERRY B NP
TUPELO
MS
00880126
1962509620
STEWART, TONYA C OD
CLINTON
MS
00660067
1891720454
STIFF, SONJA T DMD
WHITFIELD
MS
00660135
1174590319
STINGLEY, AILEAN DMD
RALEIGH
MS
00660175
1356562896
STINNETT DENTAL CARE LLC
HOLLY SPRINGS
MS
07985351
1427406123
STINSON JR, GERALD W OD
LEXINGTON
MS
04431721
1962641704
STINSON, JOSEPH M MD
JACKSON
MS
02429319
1164462248
STOCK, JOSEPH V MD
TUPELO
MS
00015240
1538187885
STODARD, MICHAEL O
MERIDIAN
MS
299
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00110173
1699884288
STOGNER, STEVEN W
HATTIESBURG
MS
04773244
1629025259
STOKER, CHAD M DDS
JACKSON
MS
09056208
1821290990
STOKES, DONNY MD
VICKSBURG
MS
08522819
1134101033
STOKES, ELIZABETH A FNP
PHILADELPHIA
MS
02580205
1821297961
STOKES, KEITH MD
NATCHEZ
MS
06253329
1376784058
STOKES, PAMELA R FNP
PHILADELPHIA
MS
00113843
1851488514
STOKLEY, CHARLES T MD
WAYNESBORO
MS
00120482
1417066226
STONE JR, JAMES E MD
TUPELO
MS
09354827
1376645697
STONE NORTHINGTON, REBECCA C FNP
TREMONT
MS
00087100
1992817597
STONE, GLEN H OD
BATESVILLE
MS
00011257
1639259534
STONE, HENRY D MD
BATESVILLE
MS
00134207
1558662965
STONE, LALETA S FNP
STARKVILLE
MS
05527532
1275874752
STONE, LANCE NP
MCCOMB
MS
00017790
1285722504
STONE, LISA B
WHITFIELD
MS
00110306
1326082231
STONE, REUBEN H MD
JACKSON
MS
07086863
1316082944
STONE, TU L OD
BATESVILLE
MS
00111924
1770689267
STONE, VAN D
TUPELO
MS
00060463
1861446668
STONE, WILLIAM P DMD
WHITFIELD
MS
01178221
1659508612
STONEFIELD, DEBORAH D CFNP
LAUREL
MS
08438368
1407215510
STONER, SARAH M NP
FLOWOOD
MS
00122401
1710919964
STONNINGTON, MICHAEL J MD
HATTIESBURG
MS
07958768
1962513267
STOREY, JOANNA M
JACKSON
MS
06334721
1467479550
STORK, JERRY L PA
HATTIESBURG
MS
08280845
1922064591
STORY, CLIFTON W MD
MISSISSIPPI STATE
MS
00060402
1568577039
STORY, DANIEL
BELZONI
MS
00115125
1396854899
STOUT, DAVID C
HATTIESBURG
MS
08572761
1760731517
STOUT, EVAN J OD
COLLINS
MS
00119630
1073555454
STOUT, MARSHALL MD
JACKSON
MS
300
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07277511
1679863633
STOUT, MICHAEL T MD
JACKSON
MS
00114267
1689751281
STOWELL, KAYE W FNP
OXFORD
MS
03334000
1184170854
STRAHAN, ALEXIS G NP-C
CLINTON
MS
01885840
1245623685
STRANCH, NICOLE MD
OLIVE BRANCH
MS
04487573
1447579446
STRANEY, MICHAEL J MD
HATTIESBURG
MS
06989379
1396299590
STRANGE JR, CHARLES R NP
GULFPORT
MS
01223735
1710241344
STRANGE, CLARKE S DMD
HOUSTON
MS
09908055
1285860387
STRANGI, JANET MD
PICAYUNE
MS
02657507
1255504213
STRAUCH, SELLY R MD
JACKSON
MS
02252842
1043262777
STRAUGHN, JOHN MD
TUPELO
MS
00060446
1578599601
STRAUGHTER, ROSE DMD
JACKSON
MS
03822511
1891906657
STREET, ERIC L MD
TUPELO
MS
00113941
1174576730
STRETCH, TOMMIE B MD
NATCHEZ
MS
00087004
1881685220
STRIBLING, GLEN H
CRYSTAL SPRINGS
MS
00087019
1245203850
STRIBLING, R K OD
PHILADELPHIA
MS
00660218
1750465456
STRICKLAND, EDWIN W DDS
WAYNESBORO
MS
00087115
1093704223
STRICKLAND, WILLIAM M OD
OXFORD
MS
00686005
1841545910
STRICKLEN, HILLARY M DO
WINONA
MS
06275586
1366791477
STRICKLEN, THERESA A CFNP
CORINTH
MS
06327842
1922486398
STRICKLIN, MISTY M NP
JACKSON
MS
00062670
1265631949
STRINGER JR, JOSEPH D DDS
WAYNESBORO
MS
00174396
1114110210
STRINGER, KIMBERLY L MD
JACKSON
MS
07634252
1225235310
STRINGER, ROBERT A MD
BRANDON
MS
00124810
1013988948
STRINGER, SCOTT P
JACKSON
MS
00116761
1629024401
STRINGER, WALTON L MD
JACKSON
MS
06924365
1790835494
STRINGFELLOW, APRIL W DDS
JACKSON
MS
01989359
1164719597
STROBEL, AMANDA L MD
JACKSON
MS
03034386
1750590196
STRONACH, BENJAMIN M MD
JACKSON
MS
301
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00019234
1134149248
STRONG JR, WILLIAM B MD
HATTIESBURG
MS
00634750
1144668146
STRONG, KIMBERLY E NP
BRANDON
MS
07038745
1336351659
STRONG, LEIGH A MD
HATTIESBURG
MS
06832032
1902992118
STRONG, MARK H MD
OXFORD
MS
00104317
1114173796
STRONG, MARY C FNP
JACKSON
MS
09100770
1376906321
STROTHER, ANGELA W MD
JACKSON
MS
01682365
1902876238
STROUPE, WANDA S CFNP
RIPLEY
MS
05672248
1639329717
STRUBLE, KIMBERLY J PAC
OCEAN SPRINGS
MS
09576300
1356766893
STRUTCHEN, BRIGITTA J NP
JACKSON
MS
00064884
1538188313
STUARD, JAMES H DMD
MAGEE
MS
07457849
1689829525
STUART, DANIEL P ACNP
JACKSON
MS
00119442
1750424529
STUBBLEFIELD, EARL T
FLOWOOD
MS
09135850
1003026345
STUBBLEFIELD, GRAVES C
JACKSON
MS
08832309
1720193675
STUBBS, JODI NP
JACKSON
MS
00012515
1659312585
STUBBS, KENNETH W
NATCHEZ
MS
05481207
1134300569
STUCKEY FAMILY DENTISTRY PLLC
GREENWOOD
MS
09372826
1689696627
STUCKEY, JACKIE B CFNP
FOXWORTH
MS
00017817
1225022213
STUDDARD, JOHN E MD
JACKSON
MS
00122797
1437240603
STURDAVANT, THOMAS E MD
BILOXI
MS
00558338
1861934184
STURDIVANT, VICTORIA J NP-C
SARDIS
MS
07236561
1275733636
SUARES, ROBERT MD
GREENVILLE
MS
00016504
1467566521
SUARES, ROBERT N MD
GREENVILLE
MS
09232094
1194808030
SUBAUSTE, ANGELA R MD
JACKSON
MS
00122769
1194758292
SUBAUSTE, JOSE` MD
JACKSON
MS
00118984
1962628966
SUBER, TRACI D WHNP
HATTIESBURG
MS
00019365
1154353852
SUBRAMONY, CHARU N MD
JACKSON
MS
00126115
1528096849
SUDDERTH, STEPHEN D MD
VICKSBURG
MS
09570031
1982656773
SUGG, REBECCA M MD
JACKSON
MS
302
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08340202
1487883088
SUGGS, BRADLEY J MD
JACKSON
MS
02936811
1982868030
SUKUMARAN, ANJU P MBBS
JACKSON
MS
09609363
1386010379
SULLIVAN, AMANDA T CFNP
FLOWOOD
MS
00012910
1164592044
SULLIVAN, B T DPM
JACKSON
MS
00018138
1386751329
SULLIVAN, DAVID M MD
JACKSON
MS
00125865
1851399638
SULLIVAN, DAVID W MD
SOUTHAVEN
MS
00120619
1174620652
SULLIVAN, DEBORAH
MEADVILLE
MS
06272293
1194980748
SULLIVAN, ELIZABETH MD
HATTIESBURG
MS
09207367
1679995112
SULLIVAN, HAZEL L ACNP
MERIDIAN
MS
00114346
1457409807
SULLIVAN, JERRY
WOODLAND
MS
07704363
1497976617
SULLIVAN, LISA M MD
JACKSON
MS
04786322
1861608721
SULLIVAN, MEGHAN D MD
SOUTHAVEN
MS
04950045
1265983316
SULLIVAN, MOLLY M NP-C
JACKSON
MS
00114928
1932176641
SULLIVAN, SABRA
JACKSON
MS
00173041
1336495621
SULLIVAN, SHANNON A MD
PASCAGOULA
MS
01212067
1073735114
SULLIVAN, SPENCER K MD
MADISON
MS
00115788
1760598569
SULLIVAN, SUZANNE R MD
FLOWOOD
MS
00117849
1598716573
SULLIVAN, VALERIE O FNP
LOUISVILLE
MS
00118398
1033177894
SULLIVAN, WILLIAM B MD
HATTIESBURG
MS
00119394
1659385276
SULLIVAN, WILLIAM D
LAUREL
MS
00116938
1366543522
SULLIVAN-FORD, RHONDA K
JACKSON
MS
00015814
1184631293
SULSER, RALPH E MD
JACKSON
MS
04377714
1699938498
SULTAN, SHAHJAHAN MD
OCEAN SPRINGS
MS
07331261
1700076940
SULTANA, AQFA MD
JACKSON
MS
00117894
1972577930
SULTANI, MTANIUS
CLARKSDALE
MS
07980811
1508236415
SUMERFORD, BETHANY C NP
JACKSON
MS
08725789
1508193459
SUMERFORD, DAVID B
TUPELO
MS
09532822
1437278371
SUMLIN-BROWN, CHANDRA R PMHNP
MERIDIAN
MS
303
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08826864
1508843772
SUMMERLIN, HOLLY G MD
GULFPORT
MS
00113488
1336257500
SUMMERS, JEFFREY T MD
FLOWOOD
MS
00113541
1619907318
SUMMERS, RICHARD L MD
JACKSON
MS
00121795
1073684940
SUMMERS, TIMOTHY MD
MERIDIAN
MS
00120880
1902873813
SUMMERSGILL, LOUIS E M.D.
PICAYUNE
MS
00660366
1649373218
SUMNER, TRICE W DDS
TUPELO
MS
04729081
1215971288
SUMRALL, BRADLEY F PA
COLUMBUS
MS
00120998
1427095579
SUMRALL, CHRYSTAL A MD
LAUREL
MS
00115271
1912017468
SUMRALL, DAWN M
MCCOMB
MS
00116658
1982672820
SUMRALL, DOYLE F MD
COLUMBUS
MS
03622063
1568869881
SUMRALL, JESSICA F OD
MONTICELLO
MS
02380775
1417040015
SUMRALL, JOSEPH C DO
PICAYUNE
MS
00062702
1285646216
SUMRALL, LARRY DDS
TAYLORSVILLE
MS
08273015
1477756153
SUMRALL, STEPHEN R MD
MERIDIAN
MS
03937269
1386046704
SUMRALL, STEPHENY NP
HATTIESBURG
MS
00112950
1073527743
SUNDARAM, MECHERI M MD
JACKSON
MS
05626773
1811359938
SUNDEEN, AIMEE D MD
JACKSON
MS
00660341
1346399953
SURBER, STEPHEN L
ELLISVILLE
MS
04124398
1760426563
SURGICAL CLINIC OF BILOXI PA
D'IBERVILLE
MS
04459841
1851374300
SURLES, CARLES R
SOUTHAVEN
MS
00676779
1134142821
SUROWIEC, WALTER J MD
GULFPORT
MS
04424868
1558688523
SUSAI, IMMANUEL MD
GULFPORT
MS
00126178
1568542892
SUTHERLAND, JAMES W MD
VICKSBURG
MS
01607351
1093265415
SUTHERLAND, KATHERINE C FNP-C
JACKSON
MS
00119309
1497705453
SUTTLE, SAMUEL K
ACKERMAN
MS
02553102
1790067486
SUTTON, ABBY G NP
TUPELO
MS
00017346
1336252774
SUTTON, JAMES D MD
OCEAN SPRINGS
MS
00114851
1902018716
SUTTON, LAWRENCE M
YAZOO CITY
MS
304
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09277069
1780747709
SUZUKI, TAKEKI MD
JACKSON
MS
00589511
1972943249
SWAMINATHAN, NISHA MD
JACKSON
MS
00125334
1932130960
SWAN, REBECCA E FNP
HATTIESBURG
MS
08489751
1386815694
SWANN, HEATHER N FNP
GULFPORT
MS
02835505
1407127327
SWANSON II, CHARLES E DO
BURNVILLE
MS
09672259
1972943231
SWANSON, WADE DO
MAGEE
MS
07526059
1821352220
SWE, EI K MD
JACKSON
MS
08402770
1093139214
SWEARENGEN, KORI FNPBC
SOUTHAVEN
MS
01450274
1023320280
SWIFT, CHRISTOPHER W DO
MERIDIAN
MS
02150341
1750797700
SWIFT, RICHARD E PA
SOUTHAVEN
MS
01488072
1508317405
SWITZER, CAYLA NP
PASCAGOULA
MS
02623356
1245346709
SYKES JR, LEON N MD
JACKSON
MS
00116660
1497848931
SYKES, PAMELA O MD
COLUMBUS
MS
01620088
1699157081
SYKES, TARA NP
JACKSON
MS
06187511
1033437587
SYKES, TARA L FNP
DIAMONDHEAD
MS
05437508
1144683897
SYMES, JOSHUA Z MD
JACKSON
MS
06936896
1043268535
SYMMES, MARY E CFNP
BILOXI
MS
09723311
1972786150
SZATMARY, GABRIELLA MD
HATTIESBURG
MS
06109246
1760619563
TA, LAN Q MD
TUPELO
MS
00019568
1679726905
TABATABAII, ASHRAF MD
PICAYUNE
MS
00121836
1316916844
TABB, LESLIE C CFNP
CLEVELAND
MS
02831321
1801182860
TABBA, LARAIB MD
PHILADELPHIA
MS
08773393
1962518217
TABLES, LAKESHA A MD
EUPORA
MS
00119852
1588627244
TABOR, ERIC N MD
PICAYUNE
MS
00122708
1700877537
TAH-CLAYTON, BRIDGET Y DO
HATTIESBURG
MS
03404537
1669468336
TAHBOUD, IMAD MD
JACKSON
MS
06271218
1770873721
TAHERI, MICHELLE N MD
CANTON
MS
02974394
1225299035
TAHIRAJ, GENTI
NEW ALBANY
MS
305
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02621361
1700147238
TAKA, NCHANG MD
JACKSON
MS
00117307
1962594036
TAKKALLAPALLI, TAKKALLAPALLI MD
JACKSON
MS
07555822
1699018028
TALATI, CHIRAG P MD
JACKSON
MS
07336536
1851608285
TALBERT, WHITNEY M DMD
SEBASTOPOL
MS
00114178
1912095100
TALBOT, PAUL J MD
HATTIESBURG
MS
00125190
1851332381
TALBOTT, DAVID W MD
JACKSON
MS
08028887
1548683790
TALLEY, ASHLEY M FNP-B
CORINTH
MS
00118029
1629078746
TALTON, DAVID S
TUPELO
MS
08434271
1649466954
TALUKDAR, NAZMUL K MD
HATTIESBURG
MS
03058068
1932262615
TALWAR, HARPREET K MD
JACKSON
MS
00121210
1881753986
TAMBOLI, KAIZAD P MD
GULFPORT
MS
00120860
1083689277
TAMBURINO, LAWRENCE E
BRANDON
MS
02238867
1578891503
TAN, JIAHUAI MD
TUPELO
MS
00122175
1124033055
TANAKA, GUILLERMO J
JACKSON
MS
07278029
1992980767
TANAWUTTIWAT, TANYANAN MD
JACKSON
MS
01239701
1427015809
TANG, SHOU-JIANG MD
JACKSON
MS
07436573
1124382536
TANGELLA, SUDHEER MD
JACKSON
MS
00119396
1184638033
TANIOUS, AREMMIA D MD
LAUREL
MS
00660328
1710111034
TANKERSLEY, JERRY D DMD
CLARKSDALE
MS
00126146
1083654578
TANN, THOMAS M MD
OXFORD
MS
01572511
1275804270
TANNER, ANTHONY T FNP
HURLEY
MS
00939591
1679732788
TANNER, ERIKA L MD
MADISON
MS
00124325
1336237825
TANNER, JOHNSON D
RIDGELAND
MS
00117378
1497846471
TANNER, YVONNE W
GREENWOOD
MS
09471531
1316158900
TAPPS, BARBARA FNP
JACKSON
MS
00000274
1831144989
TARANTOLA, AMIE L NP
OXFORD
MS
04507731
1538219399
TARBUTTON, GEORGE L MD
LAUREL
MS
04821760
1366598203
TARSHA C AMBEAU
NATCHEZ
MS
306
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00116050
1023081478
TARTT, STEPHEN W MD
MERIDIAN
MS
07483295
1013942895
TARVER, KIMBERLY C MD
JACKSON
MS
00115330
1255390472
TATE, CRYSTAL MD
NEW ALBANY
MS
05729575
1659766855
TATE, DIANA R MD
JACKSON
MS
02339040
1518111723
TATE, SARA P NP
TUPELO
MS
04184560
1124411004
TATE, SUNJA N NP
MCCOMB
MS
03228399
1538589601
TATUM, ANGELA B FNP
TUPELO
MS
04675362
1942759766
TATUM, LINDSEY K NP
JACKSON
MS
00120001
1285791319
TATUM, ROBERT E MD
CANTON
MS
01006044
1952395899
TAVAI, GREGORY MD
HATTIESBURG
MS
03557811
1962799221
TAWFIK, TAMIR A MD
JACKSON
MS
03882244
1356409312
TAYAG, EMILIO C MD
GULFPORT
MS
00124636
1710916564
TAYARA, WAKKAS MD
GULFPORT
MS
02302395
1811370075
TAYEH, AHMED A MD
JACKSON
MS
00017454
1447213509
TAYLOR JR, WALTER T MD
GRENADA
MS
01032039
1093093965
TAYLOR MIDDLETON, ANNA OD
KOSCIUSKO
MS
09482518
1811360993
TAYLOR, ALEX B MSN
JACKSON
MS
08027361
1417357468
TAYLOR, ALLISON B FNP
TUPELO
MS
00064960
1386786804
TAYLOR, ANDREW C DMD
JACKSON
MS
00126044
1699774810
TAYLOR, ANGELA F CFNP
TUPELO
MS
04432807
1912112780
TAYLOR, ANNA P OD
BRANDON
MS
TAYLOR, ANNIE W DMD
JACKSON
MS
00064669
Jun 11, 2017
06852215
1669826111
TAYLOR, ANTOINETTE R MD
JACKSON
MS
03483293
1952695496
TAYLOR, BRANDIE W FNP-C
TUPELO
MS
05880841
1053605006
TAYLOR, BRANDON A MD
SOUTHAVEN
MS
07556881
1588876338
TAYLOR, CHARLES G DDS
VICKSBURG
MS
08237567
1043622939
TAYLOR, CHARLOTTE S MD
JACKSON
MS
03604211
1508186990
TAYLOR, DAVID P MD
GULFPORT
MS
307
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04338031
1346634888
TAYLOR, DAWN L FNP
JACKSON
MS
07872714
1326165218
TAYLOR, DEBRA L FNP-C
CANTON
MS
07951751
1619211992
TAYLOR, DEONTRANESE T FNP
MONTICELLO
MS
00660043
1982918066
TAYLOR, ELIZABETH S DMD
GULFPORT
MS
06877361
1588649321
TAYLOR, FUNMINIYI A MD
JACKSON
MS
06704825
1114104734
TAYLOR, HEATHER T NP
SEBASTOPOL
MS
08305840
1619292307
TAYLOR, HUBERT D DO
GRENADA
MS
03631578
1497742506
TAYLOR, JAMES P MD
JACKSON
MS
00660268
1093730517
TAYLOR, JAMES R
CLEVELAND
MS
01600357
1154686541
TAYLOR, JARED K MD
WHITFIELD
MS
05626735
1649481607
TAYLOR, JASON K MD
JACKSON
MS
06437746
1013357615
TAYLOR, JENNIFER L NP
BURNSVILLE
MS
06321718
1356605752
TAYLOR, JEREMY S MD
JACKSON
MS
00114278
1851347215
TAYLOR, JR, JOE E FNP
PRENTISS
MS
06400753
1235339516
TAYLOR, KATHRYN G MD
BRANDON
MS
04155354
1487030987
TAYLOR, KRISTI NP-C
LAUREL
MS
01286571
1730550419
TAYLOR, MAGGIE FNP
NORTH CARROLLTON
MS
00016866
1720092414
TAYLOR, MALCOLM P MD
JACKSON
MS
02782381
1174629257
TAYLOR, MARY B MD
JACKSON
MS
07306733
1124102561
TAYLOR, MARY E CFNP
JACKSON
MS
00114995
1225094261
TAYLOR, MAX R
TUPELO
MS
03778390
1518210301
TAYLOR, MEREDITH B PA C
VICKSBURG
MS
02907245
1093888539
TAYLOR, MICHELLE V CFNP
JACKSON
MS
06775254
1558523464
TAYLOR, MONTOYA K MD
JACKSON
MS
03852531
1760860373
TAYLOR, NESCATERICA D NP
GULFPORT
MS
00116430
1477592632
TAYLOR, PAMI J MD
TUPELO
MS
08200531
1265587216
TAYLOR, PATRICIA D NP
ACKERMAN
MS
05784001
1467681726
TAYLOR, RHONDA M FNP
WALNUT
MS
308
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04531263
1972863165
TAYLOR, ROBIN M MD
OLIVE BRANCH
MS
03439090
1750646832
TAYLOR, SHANNON M DMD
BYHALIA
MS
03157396
1558391326
TAYLOR, SUSAN G MD
COLUMBUS
MS
02350579
1376609768
TAYLOR, SUSAN H MD
WHITFIELD
MS
04554277
1972538718
TAYLOR, TAMMY T FNP
CLARKSDALE
MS
09605501
1093040057
TAYLOR, THOMAS M NP
FULTON
MS
08627309
1801202619
TAYLOR, YOLANDA J DMD
BILOXI
MS
08255863
1336403740
TAYLOR-WEATHERLY, LYSSA MD
JACKSON
MS
08025360
1467799494
TEATES, ASHLEIGH B NP-C
OCEAN SPRINGS
MS
02378381
1205875143
TEFERRA, MESERET MD
JACKSON
MS
00122984
1093891657
TEMPLE, DAVID M MD
JACKSON
MS
00123093
1295776078
TEMPLE, KAREN S FNP
LAUREL
MS
07172762
1689027492
TEMPLE, KELSA A FNP
HATTIESBURG
MS
04602204
1487900098
TENHET, ALISHA B FNP
ACKERMAN
MS
00011031
1275543597
TENNIN JR, LC MD
CANTON
MS
08520829
1366599177
TER HARR, BRIANNA K MD
JACKSON
MS
00111878
1316909724
TERRACINA, JOSEPH R MD
GREENVILLE
MS
04838261
1225447923
TERRELL, LISA H NP
FLOWOOD
MS
00117983
1033137112
TERRELL, ROBERT E MD
VANCLEAVE
MS
00117049
1407887797
TERRY, COOPER L MD
OXFORD
MS
00122359
1376555334
TERRY, III, JOE W M.D.
MADISON
MS
07021253
1225228661
TESNAR, BRIAN PA
PASCAGOULA
MS
00274851
1588875363
TESSENEER, DERRICK H MD
FLOWOOD
MS
00014390
1609803139
TEW, WILLIAM E
JACKSON
MS
06352801
1669768230
TEWARI, JIGYASA MD
JACKSON
MS
00880169
1861540163
TEWIS, BARRY W OD
HATTIESBURG
MS
05200092
1760822191
TEYMOORIAN, ARIAN MD
JACKSON
MS
00203599
1164510491
THAGGARD, ANSON L MD
JACKSON
MS
309
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00113689
1659352011
THAGGARD, MICHAEL S MD
ARMORY
MS
00123654
1114923547
THAGGARD, WILLIAM G MD
MERIDIAN
MS
01636822
1346357092
THAKARE, PRADEEP V MD
GREENVILLE
MS
04532717
1457320129
THAKUR, ABHASH C
GREENWOOD
MS
05322067
1861547317
THALKEN, GREGORY L MD
JACKSON
MS
00113245
1851304026
THAMES, AMILIE T MD
GULFPORT
MS
07904282
1639568892
THAMES, KATHERINE H CFNP
BILOXI
MS
00060277
1104914431
THAMES, WALTER A DMD
NETTLETON
MS
00505711
1861597742
THANNUM, SHELLY MD
OLIVE BRANCH
MS
THARP, GREGGORY E DMD
JACKSON
MS
00660318
Jun 11, 2017
00880103
1427121268
THARP, PAMELA D OD
JACKSON
MS
00880105
1881767531
THARP, ROBERT M OD
JACKSON
MS
03185790
1053541581
THARPE, CHET A MD
JACKSON
MS
08486381
1356494264
THERESA L SKELTON
GREENVILLE
MS
04935341
1255643268
THERIOT, CHRISTIE H MD
TUPELO
MS
09854501
1730313974
THERRIEN, DAVID S MD
OXFORD
MS
09551262
1073886875
THIBODEAUX, ANDREW J DO
JACKSON
MS
04105307
1891067336
THIBODEAUX, RACHEL L DO
CORINTH
MS
00114179
1992810691
THIEL, ADELE A MD
FLOWOOD
MS
00937715
1952409609
THIELING, CRAIG A MD
HATTIESBURG
MS
07087533
1578942892
THIESEN, JORDAN D DO
JACKSON
MS
00017451
1710921895
THIGPEN, JAMES T
JACKSON
MS
01953516
1891992640
THIGPEN, SAMUEL C MD
JACKSON
MS
00124838
1841309317
THOMAS III, WILLIAM O MD
HATTIESBURG
MS
03129063
1619357050
THOMAS, AMBER D AGNP
PHILADELPHIA
MS
08708761
1831453091
THOMAS, AMY M FNP
BOLTON
MS
00087013
1669535761
THOMAS, ANGELA M
KOSCIUSKO
MS
00121537
1639156235
THOMAS, ANTHONY L MD
MERIDIAN
MS
310
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07130371
1538179668
THOMAS, BLAKE D DDS
QUITMAN
MS
09032325
1538469689
THOMAS, CARRICKA C NP
GULFPORT
MS
00126802
1093796500
THOMAS, CATHERINE M MD
HATTIESBURG
MS
03779859
1083894919
THOMAS, DALGLIESH D CFNP
MOUND BAYOU
MS
02988222
1720483779
THOMAS, DIANNA M
BILOXI
MS
05457378
1760550990
THOMAS, DONNA CFNP
JACKSON
MS
00118901
1396824124
THOMAS, ELIZABETH P FNP
BATESVILLE
MS
00113845
1811953888
THOMAS, HAROLD R MD
AMORY
MS
00119589
1982702155
THOMAS, JACKSON S MD
CORINTH
MS
05724030
1245338441
THOMAS, JENNIFER A MD
GAUTIER
MS
02376302
1396829214
THOMAS, JOSHUA W MD
GULFPORT
MS
00406768
1831486992
THOMAS, KATHRYN S MD
JACKSON
MS
07459361
1396159026
THOMAS, KATHY B ANP
TUPELO
MS
05957002
1891900569
THOMAS, KENNETH R MD
STARKVILLE
MS
00639368
1740634195
THOMAS, MARTHA C MD
JACKSON
MS
04782227
1801288410
THOMAS, NELDA C NP
JACKSON
MS
00125897
1407870306
THOMAS, SANDRA F FNP
JACKSON
MS
07552223
1972865871
THOMAS, STACY P FNP
OXFORD
MS
06981282
1497864698
THOMAS, STEFANIE M DPM
CLINTON
MS
05122053
1710302922
THOMAS, TAMRA L FNP
HATTIESBURG
MS
03529269
1427252329
THOMAS, TARA Y MD
WIGGINS
MS
00050563
1518378389
THOMAS, TIFFANY A NP-C
JACKSON
MS
04784050
1184091894
THOMAS, WYCONDAROGA E FNP
SHAW
MS
02334368
1225361702
THOMASON, DALLAS M PA
VICKSBURG
MS
07582227
1114137155
THOMASSON JR, JAMES D MD
JACKSON
MS
03052761
1336426543
THOMPSON, ADRIAN B NP
JACKSON
MS
00019785
1518901255
THOMPSON, ALLEN H
GREENVILLE
MS
00880217
1952432262
THOMPSON, BRADLEY M OD
FOREST
MS
311
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02052318
1578819835
THOMPSON, COURTNEY D OD
JACKSON
MS
00660166
1518065713
THOMPSON, CYNTHIA D
BATESVILLE
MS
09073381
1033585286
THOMPSON, DEIDRA L PMHNP
JACKSON
MS
00108254
1194710947
THOMPSON, DWIGHT E DDS
BYHALIA
MS
00304573
1811935927
THOMPSON, ELAINE A
SOUTHAVEN
MS
02079718
1194956755
THOMPSON, ELIZABETH K APRN
BURNSVILLE
MS
01584783
1598042525
THOMPSON, EMILY O NP-C
BROOKHAVEN
MS
00125621
1043296957
THOMPSON, GREGORY L MD
OXFORD
MS
04770521
1023403524
THOMPSON, JAMES E MD
JACKSON
MS
00123445
1811922172
THOMPSON, JAMES R MD
JACKSON
MS
00125020
1023005535
THOMPSON, JEFFREY D MD
OLIVE BRANCH
MS
05103721
1952665325
THOMPSON, JENETTA A MD
JACKSON
MS
09006590
1962511212
THOMPSON, JOHN K DO
HATTIESBURG
MS
00112860
1134154339
THOMPSON, JR., ROBERT F MD
TUPELO
MS
01183775
1417397837
THOMPSON, JULIA A MD
JACKSON
MS
08131244
1861423691
THOMPSON, KAREN DO
COLUMBUS
MS
08204334
1366840829
THOMPSON, MICAH B FNP
NEW ALBANY
MS
07205831
1952536641
THOMPSON, NORFLEET B MD
SOUTHAVEN
MS
06525777
1417372400
THOMPSON, PAMELA J NP
RIDGELAND
MS
05438580
1902926488
THOMPSON, PATRICIA A NP
WIGGINS
MS
02029506
1598045833
THOMPSON, REBECCA A NP
NEW ALBANY
MS
04889024
1851767644
THOMPSON, SARAH C MSN
JACKSON
MS
04577754
1740221365
THOMPSON, STANLEY C MD
SOUTHAVEN
MS
09426886
1811150402
THOMPSON, STEPHANIE FNP
HICKORY FLAT
MS
00010274
1376518308
THOMPSON, TIMOTHY F
NEW ALBANY
MS
03520851
1578747390
THOMPSON, TIMOTHY L MD
HATTIESBURG
MS
02531748
1639501380
THOMPSON, TYLER W FNP
BROOKHAVEN
MS
01889374
1235164021
THOMPSON, WILLIAM O MD
JACKSON
MS
312
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00017239
1003989245
THOMPSON, WILLIAM P MD
YAZOO CITY
MS
00124524
1477644466
THOMPSON, YOLANDA NP
GREENWOOD
MS
02824552
1639350150
THOMPSON-DAVIS, JENNIFER L MD
IUKA
MS
03603097
1154580249
THOPPIL, DEEPU R MD
HATTIESBURG
MS
01573566
1740250331
THORDERSON, NELS W MD
TUPELO
MS
00075767
1306244298
THORN, RYAN C NP-BC
COLUMBUS
MS
09775722
1467559476
THORNE, KEITH D MD
JACKSON
MS
00121103
1417944331
THORNHILL, BRENDA K CFNP
COLUMBIA
MS
06727269
1487960159
THORNHILL, CHRISTY J NP
SOUTHAVEN
MS
04901351
1346691714
THORNTON, BILLY J PMHNP
HATTIESBURG
MS
09503071
1528102506
THORNTON, DONNYEL T MD
SOUTHAVEN
MS
08983056
1699088559
THORNTON, JESSICA L NP
SOUTHAVEN
MS
00120227
1235249046
THORNTON, JON D MD
HATTIESBURG
MS
01337064
1851757413
THORNTON, KELLIE J NP
TUPELO
MS
00086795
1750492203
THORNTON, KELLY B
BOONEVILLE
MS
07288881
1609071265
THORNTON, LAURIE H CFNP
HAZLEHURST
MS
00120287
1043318280
THORNTON, LEE K MD
MERIDIAN
MS
00118902
1073545042
THORNTON, MARY FNP
MCCOMB
MS
08132814
1588870224
THORNTON, STANLEY N MD
HATTIESBURG
MS
04382897
1952742991
THOTA, NAGANATH MD
SOUTHAVEN
MS
04634811
1881909125
THRASH, BRENDA K NP
PHILADELPHIA
MS
00055727
1164663936
THRASH, CHRISTIE A NP
GULFPORT
MS
00112961
1225046543
THREADGILL, STEPHEN T MD
OXFORD
MS
00127085
1689673071
THRIFFILEY IV, JAMES MD
GULFPORT
MS
05654509
1740337625
THROCKMORTON, THOMAS W
SOUTHAVEN
MS
00239001
1982895827
THUMMA, VIJAY MD
SOUTHAVEN
MS
00016823
1194839779
THURBER, GEORGE M
BILOXI
MS
04532801
1275897670
THURMOND, PATRICK R DO
JACKSON
MS
313
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00114939
1679506760
TIBBS III, ROBERT C MD
CLEVELAND
MS
00118835
1861498610
TIBBS, PATRICIA A MD
ELLISVILLE
MS
09365606
1578665394
TICE, ELIZABETH G DPM
JACKSON
MS
01484713
1255617973
TICE, SHELIA A CFNP
NEW ALBANY
MS
02337785
1275827958
TIDWELL, AMY D ACNP
OXFORD
MS
04587001
1538134994
TIDWELL, CHRISTOPHER W OD
TUPELO
MS
07932041
1558661892
TIDWELL, ELESHA P NP-C
TUPELO
MS
04058351
1801072632
TIDWELL, WILLIAM D MD
TUPELO
MS
06238338
1962780023
TIEU, BRIAN C MD
JACKSON
MS
05032326
1710227905
TILLERY, CASEY CFNP
MERIDIAN
MS
00064789
1033120001
TILLERY, DOUGLAS W DDS
LAUREL
MS
00112524
1275648099
TILLEY, RICHARD H MD
GULFPORT
MS
00087039
1275630626
TILLMAN JR, CHARLES P
EUPORA
MS
01329761
1528445624
TILLMAN, TAMMIE L NP
JACKSON
MS
03679874
1194175273
TILLOTSON, ETHAN L
TUPELO
MS
00114041
1023194867
TIMM, DAVID A
NATCHEZ
MS
05983815
1477575561
TIMS, BROOK B CFNP
ROSEDALE
MS
08002751
1043584204
TINDALL, CYNTHIA N CFNP
GRENADA
MS
06684078
1700975984
TINGLE, CAROLYN V MD
WHITFIELD
MS
04103575
1700983285
TINSLEY, KENNETH B FNP
JACKSON
MS
04078504
1619160215
TINSLEY, TOBBY M MD
MCCOMB
MS
09826765
1407807159
TIPNIS, NEELESH A MD
JACKSON
MS
05375758
1225089972
TIPNIS, SAJANI M MD
JACKSON
MS
00012670
1548366768
TIPTON JR, ANCEL C MD
JACKSON
MS
00115059
1013918986
TIPTON JR, RAYMOND E MD
GULFPORT
MS
04684771
1316257116
TIPTON, JEFFREY P NP
GULFPORT
MS
05205556
1992060669
TIPTON, MATTHEW T DO
RIPLEY
MS
02483767
1699101139
TISCARENO, JENNERFER A MD
JACKSON
MS
314
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02873853
1164526281
TITTLE, RODNEY A DMD
MANTACHIE
MS
02779399
1568492866
TITZLER, ROBERT P MD
OCEAN SPRING
MS
00112098
1922039528
TIWARI, SALIL C MD
JACKSON
MS
02339062
1104002047
TOCZYL, GREGORY R MD
JACKSON
MS
03928708
1750691465
TODD, DAPHNE NP
JACKSON
MS
02377725
1578944807
TODD, ELIZABETH L DMD
NETTLETON
MS
01529328
1255414280
TODD, LASTEFFIA J FNP
CHOCTAW
MS
00016755
1124016282
TODD, MICHAEL A MD
NEW ALBANY
MS
06107761
1366765158
TOFTS, RYU P MD
COLUMBUS
MS
01857251
1023346137
TOLAR, MELISSA R NP
OXWORTH
MS
00660317
1225051899
TOLBERT, CHARLES C DMD
JACKSON
MS
00660400
1912028044
TOLBERT, KIMBERLY W DMD
CLINTON
MS
00115308
1841295573
TOLER, KENNETH P
JACKSON
MS
03755515
1093747776
TOLLEFSON, BRIAN J MD
JACKSON
MS
02272710
1275705949
TOMAJIAN, SAMIR A MD
GULFPORT
MS
00124159
1073519260
TOMLIN, LISA H CRNP
STARKVILLE
MS
04581039
1053536045
TOMLINSON, CLARA DDS
BATESVILLE
MS
04425051
1578602199
TOMLINSON, DONNA D FNP
HATTIESBURG
MS
00886811
1922235142
TOMLINSON, SCOTT M DMD
HATTIESBURG
MS
00087042
1679553697
TOMSIK, MARK D
MOSS POINT
MS
01275350
1013328780
TONKIN, GABRIEL W MD
JACKSON
MS
02234266
1336563279
TONKINSON, SANDRA NP
OXFORD
MS
00120381
1730270885
TONORE, THAIS B MD
JACKSON
MS
09721771
1184035172
TOOLE, MEGAN MD
JACKSON
MS
07352259
1174766182
TOOM, PRATIMA MD
TUPELO
MS
03652892
1265896807
TOPALOGLU, ALI K MD
JACKSON
MS
02338269
1073763967
TOPPS-JONES, NOKITA V PMHNP
JACKSON
MS
08970005
1407110554
TORRENCE, CHASITY L MD
WHITFIELD
MS
315
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07656862
1467500173
TORRES, FRANK X MD
JACKSON
MS
05838065
1750693206
TORREY, ALAN J MD
JACKSON
MS
06126396
1356442578
TORREY, BRIAN S
RIDGELAND
MS
01537093
1164856894
TOTTY, KATHERINE B NP
RIDGELAND
MS
02104220
1194967794
TOUCHSTONE, AMBER L FNP
LAUREL
MS
00123664
1881698124
TOUCHSTONE, DALE A MD
MERIDIAN
MS
05753720
1477633253
TOUCHSTONE, KAREN FNP
BUDE
MS
09521588
1588647671
TOWERY, KATRENA L FNP
HERNANDO
MS
00239831
1649244179
TOWERY, MARION W MD
JACKSON
MS
08620257
1538374145
TOY, PATRICK C MD
SOUTHAVEN
MS
00124757
1336333772
TRAMEL, CONNIE L NP
CALHOUN
MS
00120122
1518940964
TRAMILL, STEPHEN A
NEWTON
MS
02323741
1548550924
TRAMMEL, PAMELA L NP
BILOXI
MS
06303840
1710391099
TRAN, DEVIN M MD
JACKSON
MS
01424021
1356788251
TRAN, ROSEMARY D DDS
BILOXI
MS
07755759
1255767844
TRAN, THU T NP
WAVELAND
MS
02621224
1285967646
TRAN, TU HUONG T CFNP
BILOXI
MS
01634767
1477665917
TRAORE, AMINATA MD
SHUBUTA
MS
00124491
1992732127
TRAVELSTEAD, MEREDITH M MD
JACKSON
MS
03304073
1659314979
TRAVERS, ARA B MD
MOSS POINT
MS
00660299
1346263662
TRAVIS, JOANN H DMD
JACKSON
MS
08227546
1710161708
TRAVIS, PORTIA F
YAZOO CITY
MS
09675769
1881001568
TRAVIS, WENDY T
GREENVILLE
MS
00578751
1982939070
TRAWICK, CARMEN FNP
HATTIESBURG
MS
00660382
1780778084
TRAXLER, DONALD G D.M.D
QUITMAN
MS
01055804
1578851325
TRAYLOR, TANDALAYA M NP
TUPELO
MS
01878555
1013948090
TREADWELL, GEORGE H
SOUTHAVEN
MS
05070043
1801108196
TREADWELL, LAUREN B MD
JACKSON
MS
316
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08575345
1679923759
TREECE, NICHOLAS L
TUPELO
MS
05377813
1245349778
TRENARY, JUDY NP
COLUMBUS
MS
02352544
1750833984
TREST, CLINT H NP
WHITFIELD
MS
00117979
1780784496
TREST, ELIZABETH A DO
VICKSBURG
MS
04423872
1851744213
TRIEU, ANGELICA NP
VANCLEAVE
MS
09771018
1699891705
TRIHOULIS, JENNIFER G MD
POPLARVILLE
MS
04274332
1831585256
TRIKHA, RITIKA MD
JACKSON
MS
03955354
1609019165
TRIMM, KRISTI DO
MADISON
MS
08654551
1487727095
TRINANES, RAYMUNDO CFNP
BRANDON
MS
01402000
1942264023
TRIPLETT, JEFFREY T MD
GREENVILLE
MS
06127322
1558590430
TRITT, RONNIE ACNP
GRENADA
MS
03184871
1922346238
TROTTI, LEIGH H NP
JACKSON
MS
00122055
1538195805
TROUTMAN, WILLIAM B MD
JACKSON
MS
09232509
1194745638
TROY, LINDA L CFNP
SARDIS
MS
00113993
1609949692
TRUESDALE, KIM W
BROOKSVILLE
MS
04875069
1497896724
TRUITT, LAURA A WHNP
GREENWOOD
MS
00019961
1780893602
TRULY JR, WILLIAM MD
CANTON
MS
04186234
1174941553
TRUMBACH, SANDRA S NP
BAY ST LOUIS
MS
00122596
1720187354
TRUS, JOANNA M MD
GULFPORT
MS
01589776
1972633923
TRUSSELL, BRIAN S
HATTIESBURG
MS
03209066
1588980825
TRUXILLO, MARK R MD
PASCAGOULA
MS
00114733
1194819045
TSANG, BRIAN K MD
BILXOI
MS
02385379
1376613323
TSENG, IWEN DO
MERIDIAN
MS
07233815
1124574231
TUBBS, JESSICA D FNP
SARDIS
MS
04507765
1659769065
TUBBS, JOSEPH FNP
BYHALIA
MS
03451856
1871872820
TUCCIO, JENNIFER NP
BRANDON
MS
05650379
1972056299
TUCKER, BRITNEY C NP-C
CORINTH
MS
01329566
1891159604
TUCKER, CHRISTOPHER E MD
JACKSON
MS
317
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02755554
1043574445
TUCKER, DOUGLAS A MD
JACKSON
MS
03371530
1215266556
TUCKER, EMILY A FNPBC
CORINTH
MS
09558701
1780764290
TUCKER, GEORGE S MD
BATESVILLE
MS
00119441
1841332970
TUCKER, JAMES M
JACKSON
MS
08078295
1912068677
TUCKER, JOEL A MD
BILOXI
MS
08320701
1740500958
TUCKER, JOSHUA E
PASCAGOULA
MS
06601776
1992874168
TUCKER, KIMBERLY R
MERIDIAN
MS
03320306
1003170481
TUCKER, LAUREN K MD
JACKSON
MS
02202338
1043648900
TUCKER, MISTY A NP
TUPELO
MS
00111263
1295749349
TUCKER, PATRICK E M.D.
CORINTH
MS
00123085
1316040850
TUCKER, ROBERT L CNP
SUMNER
MS
02478201
1861501132
TUCKER, SARAH M NP
PURVIS
MS
00010261
1235155979
TUCKER, SHANE MD
NEW ALBANY
MS
05059577
1730575218
TUCKER, SHANNON E PA
JACKSON
MS
00122686
1801971379
TUCKER, SHERIDAN G MD
MREIDIAN
MS
00906512
1962684555
TULI, PAMELA J MD
GULFPORT
MS
08535509
1639309925
TULIP, HANS H MD
MERIDIAN
MS
01253237
1154347680
TULLIS, JASON E MD
JACKSON
MS
05931210
1841554250
TULLOS, BOBBY W MD
JACKSON
MS
05235071
1306254255
TULLOS, JESSICA M DO
WAYNESBORO
MS
02236231
1609105196
TULLOS, JOSEPH B FNP
CHOCTAW
MS
00116769
1255440426
TULLOS, SHERRY
HATTIESBURG
MS
00077253
1063683472
TULLOS, STEPHANIE S DMD
RALEIGH
MS
00060118
1346355286
TUMINELLO, DAVID W DDS
BAY ST. LOUIS
MS
00559777
1265877732
TUMMINELLO, KATHERINE C MD
JACKSON
MS
03072365
1649548892
TUMMINELLO, KIM M NP
PASCAGOULA
MS
00018547
1780686352
TUMMINELLO, SAM C
NATCHEZ
MS
00221827
1366575763
TURBA, JOHN MD
BROOKHAVEN
MS
318
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00120480
1912963471
TURBA, MICHELLE M NP
TUPELO
MS
00432841
1487952313
TUREK, MATTHEW H MD
GULFPORT
MS
04028766
1518159391
TUREL, BURGESE K MD
LAUREL
MS
00121122
1053306977
TURK, LEE H MD
NATCHEZ
MS
03255016
1003079955
TURNAGE, APRIL A DMD
CLINTON
MS
02454010
1457419707
TURNAGE, VICKI F CFNP
WATER VALLEY
MS
00112301
1558328484
TURNER IV, JOHN L MD
HATTIESBURG
MS
07325070
1528066552
TURNER IV, RULOFF P DO
KOSCIUSKO
MS
00111964
1356335764
TURNER, ANITA J FNP
RIPLEY
MS
00060165
1104949130
TURNER, BRIGETTA K DDS
JACKSON
MS
07203854
1386919199
TURNER, CELESTE M NP
TUPELO
MS
00010457
1285630715
TURNER, GERALD A MD
COLUMBUS
MS
09476256
1205899267
TURNER, JACKEY
OXFORD
MS
02453545
1952416109
TURNER, JAMES M DO
HATTIESBURG
MS
00087755
1750361051
TURNER, JOHN M OD
HATTIESBURG
MS
05079218
1477620458
TURNER, JR, DOUGLAS M MD
AMORY
MS
02978011
1518120096
TURNER, JUSTIN M M.D.
JACKSON
MS
05337707
1750302824
TURNER, KRISTEN Y MD
TUPELO
MS
06903758
1396297453
TURNER, LAKEITHA H NP
VICKSBURG
MS
03079808
1407130339
TURNER, LAURA B NP
COLUMBUS
MS
03553860
1336223734
TURNER, LEON C NP
TUNICA
MS
03981716
1093027385
TURNER, LINDSEY M MD
JACKSON
MS
00880034
1023101342
TURNER, MICHAEL G OD
OXFORD
MS
02720071
1548514151
TURNER, SCOTT J PMHNP
GULFPORT
MS
08755777
1922208768
TURNER, SHERRY D DO
HATTIESBURG
MS
01251358
1972527034
TURNER, VALERIE J DMD
MCCOMB
MS
03527331
1760893184
TURSE, ERICA DO
JACKSON
MS
00660444
1255439501
TUTOR, ALBERT W DMD
LEXINGTON
MS
319
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00660397
1043220312
TUTOR, HEATHER K DMD
LEXINGTON
MS
01959524
1548300841
TWAROG HUCKABEE, JACQUELINE G DDS
PASCAGOULA
MS
08373349
1902144629
TYER, HEATHER F PA
TUPELO
MS
02652876
1215133830
TYLER, JOSHUA MD
BILOXI
MS
06627042
1922469063
TYNER, KIMBERLY E FNP-C
MADISON
MS
06301074
1639547425
TYNES, BRANDI NP-C
LAUREL
MS
02251053
1659787307
TYNES, FRANCES H MSN
JACKSON
MS
00117444
1063509719
TYNES, MARSHALL S DO
MERIDIAN
MS
08439781
1033450333
TYNES, RONALD P CNP
LAUREL
MS
03181063
1578654851
TYRE LITTLEJOHN, ALENA B MD
TUPELO
MS
07856779
1265735807
UBAIDULHAQ, MUHAMMAD MD
JACKSON
MS
00125653
1447278528
UELTSCHEY, MARCUS E
SALTILLO
MS
09372327
1316261910
UGORJI, CHINEMEREM MD
JACKSON
MS
09503508
1891987160
UHL, JOHN L MD
HATTIESBURG
MS
06022776
1659355949
ULLAH, MOHAMMAD I MD
JACKSON
MS
07533276
1902048457
ULLOA, JAIRO L M.D.
GULFPORT
MS
00114181
1285616896
ULMER III, JACOB E
MERIDIAN
MS
06709263
1053486860
ULMER, APRIL L MD
OCEAN SPRINGS
MS
00854345
1598184871
ULMER, JESSICA B DDS
GULPORT
MS
08805227
1477950673
ULMER, OWEN H DO
MERIDIAN
MS
00123762
1447240494
UNDERWOOD JR, JAMES A MD
FLOWOOD
MS
02571062
1205148459
UNDERWOOD, EVAN L MD
MAGEE
MS
00060285
1154349967
UNDERWOOD, NORMAN C DDS
BYRAM
MS
00117736
1841337656
UNDESSER, CYNTHIA MD
JACKSON
MS
09880325
1124051321
UNDESSER, ERIC K MD
JACKSON
MS
00119862
1275599656
UNGO, JAIME R M.D.
TUPELO
MS
09180827
1841698792
UPCHURCH, AUDREY NP
FLOWOOD
MS
08188321
1760498620
UPPAL, ARVINDER S MD
GREENVILLE
MS
320
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125729
1710998018
UPSHAW, STACY
LUCEDALE
MS
00120942
1992870711
UPTON JR, CHARLES C MD
JACKSON
MS
00087920
1962545608
UPTON, DONALD G OD
COLUMBUS
MS
06439091
1265894380
UPTON, HUNTER B MD
JACKSON
MS
00123197
1851408744
UPTON, SHARON C ACNP
OXFORD
MS
02700811
1295967826
URIBE, JUAN D MD
JACKSON
MS
00126913
1972517308
USCHMANN, HARTMUT
JACKSON
MS
00120946
1982717971
USEY, TIMOTHY G MD
RIDGELAND
MS
00119213
1851327555
UTTERBACK, DAVID B
OCEAN SPRINGS
MS
08037711
1932133055
VAGHELA, RACHANA MD
SOUTHAVEN
MS
00112954
1649204629
VAIL, GENA A NP
NEW ALBANY
MS
02409046
1326593336
VAIL, ROBERT I FNP-C
NEW ALBANY
MS
06587241
1255645446
VAITLA, PRADEEP K MD
JACKSON
MS
00113994
1679678312
VALDEZ, MARIA V
TUPELO
MS
08486226
1497986673
VALE, HENRIQUE F MD
JACKSON
MS
01455212
1740598457
VALENTIN, GARDY MD
OXFORD
MS
00660280
1396844734
VALENTINE, BRETT A DMD
SUMRALL
MS
06584011
1700086014
VALENTINE, COURTNEY MD
LUCEDALE
MS
00126125
1841272234
VALENTINE, JAMES L DO
MERIDIAN
MS
00880174
1871653873
VALENTINE, LESLIE H OD
LUCEDALE
MS
06659073
1891792586
VALLETTE, RICHARD C MD
COLUMBUS
MS
00620215
1245322247
VALVERDE, WILLIAM M MD
JACKSON
MS
01080397
1538199831
VAMVAKAS, ANGELOS B MD
DIBERVILLE
MS
03573574
1609211374
VAN AKKEREN, JEANIE MARIE FNP-C
SALTILLO
MS
00281003
1760469571
VAN ALSTINE, DAVID A MD
OLIVE BRANCH
MS
06827854
1033506837
VAN CLEVE, APRIL K CNP
HATTIESBURG
MS
06759284
1437242724
VAN EVERY, KYMBERLY R
OXFORD
MS
08975367
1922263912
VAN HILSEN, ZACHARY DDS
PASCAGOULA
MS
321
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04583805
1689831125
VAN METER, CHARLES J DMD
BRANDON
MS
05086561
1174768287
VAN OSTEN, GEORGE K MD
TUPELO
MS
06007203
1134257629
VAN SLYKE, BOBBIE G FNP
OXFORD
MS
00095703
1245277573
VAN UDEN JR, ROBERT JR MD
MCCOMB
MS
00111206
1265521207
VANCE, GREGORY A MD
FLOWOOD
MS
00660380
1962425421
VANCE, JIMMY D DMD
JACKSON
MS
01039029
1174751093
VANCE, LINDA M NP
YAZOO CITY
MS
05238298
1588690689
VANCE, PENNY B MSN
JACKSON
MS
09739734
1487974192
VANCE, RALPH B MD
FLOWOOD
MS
00000798
1972932002
VANDERFORD, NAOMI P AGNP,
LAUREL
MS
04155392
1487619151
VANDERHEIDEN, RONDA M FNP
HATTIESBURG
MS
00117675
1609097898
VANDERLAN, WESLEY B MD
JACKSON
MS
00270041
1336451624
VANDERLOO, JOHN P MD
JACKSON
MS
05923275
1265895882
VANGALA, PRATHYUSHA MD
JACKSON
MS
05404716
1174879720
VANLANDINGHAM, ANSLEY T NP
OXFORD
MS
02153864
1093032542
VANLANDINGHAM, MATTHEW A MD
FLOWOOD
MS
00116195
1992877047
VANLANDINGHAM, PAUL D MD
JACKSON
MS
00064465
1316185572
VANN, JR., WILLIAM H DDS
LUMBERTON
MS
00119426
1386721652
VANNORMAN, KETURAH M
BRANDON
MS
04574372
1801101696
VANPELT, HEATHER M DMD
MACON
MS
08988559
1942525738
VANYPEREN, JEFFERY DPM
AMORY
MS
08236328
1376746305
VARGO, JACOB A MD
OLIVE BRANCH
MS
08130001
1386812410
VARNADO, DEWANNA R DMD
HATTIESBURG
MS
00095896
1568429124
VARNER, JAMES C MD
SOUTHAVEN
MS
07858331
1669682134
VARNER, LOUIS M MD
GULFPORT
MS
03283875
1922272459
VARNEY, KERRI M NP
VICKSBURG
MS
06402516
1477521987
VARVA, CHRIS A DPM
OXFORD
MS
01327352
1740577071
VASSAR, JASON W DMD
JACKSON
MS
322
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08883003
1790035731
VAUGHAN, CHARLENE L NP
STARKVILLE
MS
00124884
1134231541
VAUGHAN, GENIE B FNP
JAYESS
MS
05078304
1881801132
VAUGHAN, IVA N NP
OCEAN SPRING
MS
05035591
1790933752
VAUGHAN, JESSICA S NP
MERIDIAN
MS
00119435
1407958382
VAUGHAN, RAQUEL NP
SOUTHAVEN
MS
09532102
1144423005
VAUGHN, ALISHA S MD
FLOWOOD
MS
05389356
1689113250
VAUGHN, BRENNAN F PA
JACKSON
MS
00114608
1932119336
VAUGHN, CYNTHIA A
JACKSON
MS
01128596
1194925537
VAUGHN, DIANE B GNP
GULFPORT
MS
09509758
1598870032
VAUGHN, ERICKA C MD
MERIDIAN
MS
09321728
1053681213
VAUGHN, JOYCE C PMHNP
HERNANDO
MS
08952552
1174770168
VAUGHN, KRISTINA D MD
JACKSON
MS
00016774
1730199159
VEACH, CHELE A MD
BRANDON
MS
01282592
1144667122
VEDANARAYANAN, VANDANA J MD
JACKSON
MS
00019355
1174565469
VEDANARAYANAN, VETTAIKORUMAKAN V MD
JACKSON
MS
00014170
1720011778
VEERISETTY, INDIRA K MD
RIDGELAND
MS
00122454
1033196605
VEGA, CHADLEY T MD
MERIDIAN
MS
09575875
1891992434
VELASCO, DIEGO MD
HOUSTON
MS
03975094
1609939396
VELEZ, JUAN A MD
HATTIESBURG
MS
02233338
1235490780
VELUVARTI VENKATA, SREEDEVI MD
JACKSON
MS
05539596
1871570648
VENABLE, ROBERT S MD
SOUTHAVEN
MS
00125626
1003892357
VENARSKE, DANIEL L
MONTICELLO
MS
07981363
1437501475
VENATTA, EMILY W NP
GULFPORT
MS
03920824
1548406606
VERA SOTOMAYOR, ANA V MD
HATTIESBURG
MS
00117291
1558326488
VERMA, SATISH C MD
SENATOBIA
MS
01625891
1306044912
VERSTEEGH, TODD A MD
JACKSON
MS
09737862
1346318441
VERUCCHI, DEBORAH A NP
OLIVE BRANCH
MS
07583571
1841391315
VERUCCHI, MATTHEW T MD
NATCHEZ
MS
323
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00118282
1700893047
VIAL, D. FREDERICK
LAUREL
MS
00124489
1538169016
VICE, JOSEPH P MD
OCEAN SPRINGS
MS
01220266
1336167725
VICK, KENNETH D MD
JACKSON
MS
00273859
1508899642
VICK, LAURA R MD
MADISON
MS
00123316
1760428569
VICKERS, GREGORY N MD
HATTIESBURG
MS
04128351
1922497759
VICKERY, MARLENE K FNP
TUPELO
MS
09852254
1699157487
VIERLING, JADA E NP
GULFPORT
MS
00115515
1689619405
VIG, VIBHA
CANTON
MS
07000398
1275891699
VIGLIANCO, ROBIN G NP
GULFPORT
MS
09738790
1073887501
VIJ, ANGELA R MD
JACKSON
MS
08858864
1184607210
VIJAYAKUMAR, SRINIVASAN MD
JACKSON
MS
00050780
1245330935
VIJAYAKUMAR, VANI MD
JACKSON
MS
07674356
1215166798
VILLACORTA, JENNIFER M MD
JACKSON
MS
07104501
1801098611
VILLANI, JUAN P MD
JACKSON
MS
01139881
1831333871
VINCENT, LESLEY R FNP
MERIDIAN
MS
04970514
1023249497
VINCENT, LYNN A ACNP
JACKSON
MS
09702831
1295107357
VINCENT, TAMMY S NP
RIDGELAND
MS
01567538
1417133083
VINCHWATER, MICHELLE P FNP
JACKSON
MS
02339353
1306175138
VINING, DANNY NP
RIDGELAND
MS
09224339
1528440922
VINSON, CHRISTOPHER P FNP
VICKSBURG
MS
08088344
1376758029
VINSON, JANELL T MD
PHILADELPHIA
MS
06201568
1528479193
VINYARD, ASHLEE A MD
JACKSON
MS
00575220
1275795148
VIRVILIS, DIMITRIOS MD
GULFPORT
MS
00115345
1669454070
VISE, RICHARD M MD
MERIDIAN
MS
09184067
1164450524
VITALE, DANA S DO
HATTIESBURG
MS
04975750
1396151205
VLADISLAV, IOAN T MD
JACKSON
MS
00112104
1902991219
VOHRA, RAHUL
FLOWOOD
MS
00116097
1902807050
VOLLER, ROBERT D MD
COLUMBUS
MS
324
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07258537
1992177463
VON STRAHL, RHONDA L NP
TUPELO
MS
09621593
1194089508
VONGALA, AJAY R MD
JACKSON
MS
01604539
1780793059
VOSS, JOHN D
MERIDIAN
MS
00118342
1669417705
VOULTERS, LEE MD
GULFPORT
MS
05653823
1942481437
VOWELL, CHRISTY M
EUPORA
MS
01355079
1366708778
VU, ANH P MD
MCCOMB
MS
06322869
1740272723
VYVERBERG, BRYAN M MD
GULFPORT
MS
00115412
1609964683
WADDELL, DAVID I MD
FLOWOOD
MS
04989043
1629430327
WADDELL, JOHN P MD
JACKSON
MS
02425337
1720013816
WADDILL, JAMES R MD
NATCHEZ
MS
00123452
1619934940
WADE JR, FRANK C MD
JACKSON
MS
00115344
1578545984
WADE JR, STANLEY A MD
MERIDIAN
MS
04050870
1134349699
WADE, JENNIFER E APRN
TUPELO
MS
00534527
1538494489
WADE, JEREMY P NP
HATTIESBURG
MS
00376228
1245533975
WADE, KIMBERLY M DMD
JACKSON
MS
08807834
1508022476
WADE, MATTHEW J MD
COLUMBUS
MS
00115897
1043246259
WADE, TARENCE E
GREENVILLE
MS
00122170
1093819799
WADE-HAMME, JOYCE D MD
JACKSON
MS
04535864
1821291790
WADSWORTH, MARGARET C MD
JACKSON
MS
09228771
1598033227
WAGGONER, CHRISTINE R FNP
BOLTON
MS
05153323
1992058556
WAGNER, DYLAN P PA
LAUREL
MS
07376214
1396716866
WAGNER, STEVEN J MD
FLOWOOD
MS
08756546
1598127862
WAGONER, THOMAS M MD
JACKSON
MS
00012726
1952303182
WAHL, DAVID A MD
JACKSON
MS
04955378
1881884260
WAHL, GEORGIA M MD
HATTIESBURG
MS
00013243
1427090703
WAHL, NANCY G
JACKSON
MS
00018764
1942262415
WAINWRIGHT, MARION J MD
BILOXI
MS
00016544
1588773774
WAITES, THAD F MD
HATTIESBURG
MS
325
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00124360
1336187947
WAITS, JR., SAMUEL J MD
JACKSON
MS
02102752
1861747743
WALCHAK, LEANNE C MD
JACKSON
MS
00112408
1457321325
WALCOTT, DEXTER W MD
JACKSON
MS
02735217
1881815074
WALDROP, CHRISTINE MD
JACKSON
MS
01874879
1811435175
WALDROP, KELLY L CNP
FLOWOOD
MS
05989862
1306870746
WALDROP, KEVIN L MD
HATTIESBURG
MS
06487398
1467735266
WALDROP, LAUREN C FNP
TUPELO
MS
00119017
1619917275
WALDRUP, PHILLIP D MD
OLIVE BRANCH
MS
05404571
1124419031
WALKER, AMY NP
GULFPORT
MS
09352501
1558555391
WALKER, AMY L CFNP
GREENVILLE
MS
04528543
1871985564
WALKER, CHRISTOPHER L FNP-C
SALTILLO
MS
04706763
1124417761
WALKER, CLINTON S NP
MADISON
MS
07557395
1740615814
WALKER, DANIEL M NP
MORTON
MS
00121680
1558305292
WALKER, DIANE M
HATTIESBURG
MS
04201761
1801094438
WALKER, ERICA D MD
JACKSON
MS
00014220
1750494134
WALKER, GEORGE G 03
STARKVILLE
MS
00880138
1083660757
WALKER, HEDY G OD
GULFPORT
MS
07723078
1588017750
WALKER, HOLLY B NP
JACKSON
MS
05980208
1598940686
WALKER, JAMES B
JACKSON
MS
00116671
1073527230
WALKER, JIMMY A
COLLINS
MS
00118904
1710092986
WALKER, KATHRYN R
FOREST
MS
01831306
1770880445
WALKER, LATOYA R MD
LAUREL
MS
00721071
1720342108
WALKER, LEE H MD
JACKSON
MS
00660239
1265559496
WALKER, LEIGH T DMD
JACKSON
MS
02274079
1063823896
WALKER, MATTHEW L MD
JACKSON
MS
05551742
1326451741
WALKER, MICAH R MD
JACKSON
MS
09276222
1225205313
WALKER, ROBERT K MD
BROOKHAVEN
MS
00122024
1649216680
WALKER, ROBERT L
HAZLEHURST
MS
326
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00116555
1316983620
WALKER, ROSALYN C
JACKSON
MS
07989543
1124428628
WALKER, SARAH NP
LEXINGTON
MS
00116241
1932218138
WALKER, SUE D MD
HATTIESBURG
MS
00116577
1073559761
WALKER, THOMAS A MD
JACKSON
MS
08350536
1245638642
WALKER, WHITNEY NP
RIPLEY
MS
01575382
1649576539
WALKER, WILLIAM MD
HAZLEHURST
MS
00019522
1184668246
WALKER, WILLIAM E MD
HATTIESBURG
MS
00116490
1124109871
WALKER-MCNAIR, ROSIE L MD
JACKSON
MS
02581271
1417038290
WALKINSHAW, MARCUS D
JACKSON
MS
04183295
1346446671
WALL, ALLISON P MD
GULFPORT
MS
00680358
1326060070
WALL, BRIAN K MD
OXFORD
MS
01925885
1053447268
WALL, MARK B MD
BILOXI
MS
05809319
1477860526
WALLACE, CAYCE DMD
GULFPORT
MS
00117978
1336251560
WALLACE, EMERSON L CFNP
SALTILLO
MS
08128741
1881794162
WALLACE, JAMES H MD
JACKSON
MS
01325557
1316391055
WALLACE, JESSICA FNP
HOUSTON
MS
07830815
1831486596
WALLACE, JOHN G MD
KOSCIUSKO
MS
00011285
1174537708
WALLACE, JOHN M MD
LAUREL
MS
03707842
1679019350
WALLACE, KRISTEN A FNP-B
FLOWOOD
MS
00114470
1346207222
WALLACE, MELANIE E
TUPELO
MS
04387064
1508045030
WALLACE, MICKEY P MD
JACKSON
MS
00013607
1922044502
WALLACE, PERRY MD
MERIDIAN
MS
07084529
1740537687
WALLACE, SUSAN R FNP-C
HATTIESBURG
MS
03205377
1699959882
WALLACE-STEVENS, ALICIA L MD
POPLARVILLE
MS
05471708
1053592840
WALLER III, WILLIAM L MD
HATTIESBURG
MS
00117443
1497864607
WALLER JR, FRANKLIN W
COLUMBIA
MS
02700052
1194774190
WALLER, ANGELA O NP
NATCHEZ
MS
00122307
1952355653
WALLER, JASON M
OXFORD
MS
327
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00374308
1811303670
WALLER, JODI L NP
MCCOMB
MS
00115098
1821001041
WALLER, RICHARD E MD
MARKS
MS
03577341
1528373586
WALLEY, ANNA D NP
JACKSON
MS
00660286
1922117662
WALLEY, ELGIN K
JACKSON
MS
05485262
1720300734
WALLEY, JENNIFER N FNP
WAYNESBORO
MS
06883243
1407218811
WALLEY, MEGAN J MD
JACKSON
MS
00880101
1215951314
WALLS, CHRISTOPHER T OD
BATESVILLE
MS
05674025
1851555106
WALLY, RYAN S OD
OXFORD
MS
00125021
1588602049
WALROD, JOHN G MD
COLUMBUS
MS
04835363
1083054498
WALSH, KELSEY A MD
JACKSON
MS
00115142
1205895448
WALT, DAVID L MD
CLEVELAND
MS
01639092
1962639104
WALTERS HAYGOOD, CHRISTEN L MD
JACKSON
MS
07770365
1306860697
WALTERS, DORTHIA S FNP
BOONEVILLE
MS
07800068
1124274733
WALTERS, JACKSON L MD
STARKVILLE
MS
05272231
1174952899
WALTERS, KRISTEN M
PELAHATCHIE
MS
00509295
1518221175
WALTERS, LAUREN M NP
SUMRALL
MS
00720740
1396144135
WALTERS, LYDIA M FNPC
JACKSON
MS
08834379
1942645486
WALTERS, RENEE DO
TUPELO
MS
00115083
1710944699
WALTON, BILLY DO
TUPELO
MS
01137367
1871980995
WALTON, BILLY R PMHNP
WHITFIELD
MS
07038578
1013115906
WALTON, NICOLE R DO
OCEAN SPRINGS
MS
09683095
1831210608
WALTON, PERRY J DO
PASCAGOULA
MS
07630093
1710242458
WALTON, TYRONGILIA Q FNP
NEW ALBANY
MS
04933323
1730153586
WANEE, NEIL R MD
SMITHVILLE
MS
04674207
1447565239
WANG, NIPING DDS
JACKSON
MS
03229528
1396701553
WANG, ZI LIN MD
JACKSON
MS
00074777
1710376611
WANGLER, SHANEN R NP
PICAYUNE
MS
00172872
1821320201
WANSLEY, ROBERT J FNP
BAY SPRINGS
MS
328
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07388585
1750523544
WAQAS, MUHAMMAD MD
SOUTHAVEN
MS
06382561
1134596919
WARD, CASSALA S NP
CHARLESTON
MS
00124180
1316916869
WARD, DONALD
LAUREL
MS
03453796
1891926754
WARD, ELIZABETH M ACNP
JACKSON
MS
00111744
1790869626
WARD, GEORGE L MD
GULFPORT
MS
03792344
1154341774
WARD, HOLLIS L CRNP
LEAKESVILLE
MS
08072570
1750335782
WARD, IVA I FPMNP
MCCOMB
MS
00013226
1316962590
WARD, JOE A MD
JACKSON
MS
08983711
1073756227
WARD, KARA E MD
GULFPORT
MS
06138212
1932362951
WARD, KENDRIA V MD
BRANDON
MS
07852370
1821082322
WARD, KEVIN M MD
MERIDIAN
MS
06852892
1073559100
WARD, KIMBERLEY M MD
JACKSON
MS
04551897
1720283682
WARD, MARION S MD
JACKSON
MS
02659281
1821278813
WARD, MARY A FNP
MERIDIAN
MS
04481569
1336540715
WARE II, JAMES R NP
JACKSON
MS
02974597
1861411977
WARE, ALISHA H MD
GULFPORT
MS
05027085
1912258450
WARE, ASHLEY K FNP
PRENTISS
MS
08327741
1558670869
WARE, JACQUELINE S FNP
GREENWOOD
MS
09304801
1851585285
WARE, LATONYA S DDS
GRENADA
MS
00880107
1508980178
WARE, MICHAEL D OD
TUPELO
MS
00704517
1053374041
WARE, PAUL D MD
GULFPORT
MS
05778021
1689994469
WARE, SIDNEY L MD
TUPELO
MS
06932593
1225284433
WARE, TERRANCE L
JACKSON
MS
08689545
1871565135
WARLICK, DAN P MD
TUPELO
MS
04605326
1306027123
WARNER, ELIZABETH NP
LEXINGTON
MS
09274545
1285929885
WARNER, LINDSEY H DMD
STARKVILLE
MS
00125983
1356360119
WARNOCK JR, JAMES L MD
JACKSON
MS
03984571
1992758775
WARREN, ANDREA J DO
PONTOTOC
MS
329
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125912
1730114117
WARREN, ERIC J MD
BRANDON
MS
01028095
1174872626
WARREN, JENNIFER B FNP-C
SOUTHAVEN
MS
09272321
1356707400
WARREN, JENNIFER K PMHNP
TUPELO
MS
00786724
1730196353
WARREN, JOANNA NP
JACKSON
MS
08128774
1851846810
WARREN, JOANNA K CPNP
MERIDIAN
MS
08104762
1932551520
WARREN, TIFFANY L FNP
AMORY
MS
08783866
1609232123
WARREN, VICKIE L NP
MERIDIAN
MS
00115134
1306858436
WARRINGTON SR, JAMES E MD
CLARKSDALE
MS
06532769
1932590452
WARRINGTON WILLS, MALLORY M NP
OXFORD
MS
06227091
1568757201
WARRINGTON, JAMES E MD
OXFORD
MS
00115102
1912919234
WARRINGTON, JR, JAMES E DO
RULEVILLE
MS
00115140
1831168350
WARRINGTON, PAUL W MD
CLEVELAND
MS
00114997
1144286360
WARTAK, ANDRZEJ J MD
WEST POINT
MS
05479398
1093851370
WASEF, MAHA S M.D.
JACKSON
MS
02530569
1255748604
WASHBURN III, DONALD W PA
SOUTHAVEN
MS
04774800
1598053225
WASHBURN, DEBORAH M PA
GULFPORT
MS
00119935
1760455257
WASHBURNE, ELIZABETH C
HATTIESBURG
MS
00114888
1750354247
WASHBURNE, JOSEPH F
HATTIESBURG
MS
06434223
1093002768
WASHINGTON III, ANTHONY R MD
NATCHEZ
MS
09104701
1952853731
WASHINGTON, BEVERLY C PMHNP
JACKSON
MS
00124266
1063403491
WASHINGTON, CALVIN A
WIGGINS
MS
04954267
1649460999
WASHINGTON, CHAD W MD
JACKSON
MS
00117005
1437163763
WASHINGTON, CLINTON L MD
AMORY
MS
08351366
1902825573
WASHINGTON, ERIC D
PASCAGOULA
MS
00117187
1093721151
WASHINGTON, LAURA K MD
AMORY
MS
04877258
1144541970
WASHINGTON, MEGAN L DO
FLOWOOD
MS
00121450
1043212038
WASHINGTON, MICHAEL J MD
OLIVE BRANCH
MS
01080372
1679740906
WASHINGTON, NINA T MD
MADISON
MS
330
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06556734
1184016842
WASHINGTON, SECONDRIA M NP
SOUTHAVEN
MS
09450858
1396893202
WASHINGTON, SHERMAN MD
MERIDIAN
MS
08430380
1811376908
WASHINGTON, VANCE M MD
JACKSON
MS
00122832
1275638363
WASSEF, MAGDI S
SOUTHAVEN
MS
00117115
1326064601
WATERER III, HENRY C MD
JACKSON
MS
06120031
1982978607
WATERS, KRISTEN E NP
GULFPORT
MS
05722240
1316984230
WATERS, LESA F CFNP
CHOCTAW
MS
09324777
1598773897
WATKINS, CHRISTOPHER NP
WHITFIELD
MS
08935752
1912967795
WATKINS, DAWN J MD
HURLEY
MS
03407352
1962631788
WATKINS, JR, WILLIAM M MD
JACKSON
MS
03924050
1083920987
WATKINS, KATRINA M FNP
TUPELO
MS
00117238
1245323914
WATKINS, MARY S FNP
LUMBERTON
MS
09702516
1629139977
WATKINS, PAMELA H APRN
MERIDIAN
MS
09809517
1669635926
WATKINS, RANDI A FNP
CARTHAGE
MS
08456238
1962664870
WATSON, ANDREW D MD
QUITMAN
MS
03500255
1518924414
WATSON, BYRON K MD
WEST POINT
MS
01654383
1508069535
WATSON, DANCY A NNP
MERIDIAN
MS
00123750
1467435263
WATSON, JAMES R MD
MERIDIAN
MS
02928702
1851370795
WATSON, JOHN A D.O.
MCCOMB
MS
00115994
1922042407
WATSON, PAMELIA
JACKSON
MS
07820371
1558472381
WATSON, ROBERT C DMD
BASSFIELD
MS
00119484
1669413233
WATSON, ROBERT W DO
HAZLEHURST
MS
00015683
1437104155
WATSON, STEVEN J DPM
PICAYUNE
MS
00781741
1003285461
WATSON, TIMOTHY NP
RIDGELAND
MS
00125157
1992802367
WATSON, TIMOTHY B FNP
AMORY
MS
07708391
1508801366
WATTANASUWAN, NORRAPOL MD
GREENVILLE
MS
01532506
1437169844
WATTERS, CARTER L MD
JACKSON
MS
00660446
1265571491
WATTERS, GAYLE M DMD
MADISON
MS
331
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08280704
1639359268
WATTS JR, JOEL H MD
PASCAGOULA
MS
05073000
1801877022
WATTS JR, BENJAMIN P PA
VANCLEAVE
MS
07951005
1407809098
WATTS JR, ROBERT T DMD
BILOXI
MS
00660248
1245285592
WATTS, JOHN H DDS
BILOXI
MS
08857852
1962744482
WATTS, KENDRA CPNP
OCEAN SPRINGS
MS
00121282
1780802645
WATTS, THRESA K FNP
JACKSON
MS
00121640
1952489437
WAWRYSZCZUK, GREGORY B
OCEAN SPRINGS
MS
05084709
1093763245
WEARY, DANITA R M.D.
NATCHEZ
MS
07309816
1831146901
WEATHERFORD, ELIZABETH R MD
CORINTH
MS
09309350
1518308469
WEATHERLY, BRANDON B MD
JACKSON
MS
07105081
1972558542
WEATHERLY, WALLACE W MD
MADISON
MS
08954899
1871927343
WEATHERS, SHANNON C NP-C
LAUREL
MS
03689771
1225449200
WEAVER, CHRISTIAN D MD
JACKSON
MS
00064575
1841383601
WEAVER, DONALD Q
KOSCIUSKO
MS
00125324
1235248451
WEAVER, JAMES M MD
HATTIESBURG
MS
00124944
1013999838
WEAVER, PATTI S NP
MERIDIAN
MS
00062943
1396828505
WEAVER, PHILLIPS S DDS
PASCAGOULA
MS
00120046
1588608509
WEAVER, ROBERT M
PETAL
MS
00652546
1841601861
WEBB, ADRIENNE L MD
JACKSON
MS
07476720
1629365853
WEBB, CHRISTOPHER N MD
PHILADELPHIA
MS
00120803
1083685259
WEBB, DAVID E
TUPELO
MS
00113591
1801804133
WEBB, JOHN H MD
OXFORD
MS
00125781
1548357981
WEBB, KIMBERLY L DO
WATER VALLEY
MS
01009259
1497001085
WEBB, NALISHA NP
SOUTHAVEN
MS
03636336
1790125805
WEBB, RICHARD T MD
JACKSON
MS
02159215
1306874268
WEBB, RISA M MD
JACKSON
MS
00784861
1356364152
WEBB, SARAH V MD
JACKSON
MS
00424890
1699857771
WEBB, SHERYLAN A OD
STARKVILLE
MS
332
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00110736
1669446001
WEBER, BENJAMIN M MD
LAUREL
MS
06536033
1326211475
WEBER, DREW S MD
GULFPORT
MS
00010722
1003822495
WEBER, EMILY S MD
JACKSON
MS
07322505
1942367982
WEBSTER, ELLA M MD
MADISON
MS
00674799
1598811374
WEBSTER, JOHN A MD
PASCAGOULA
MS
00324551
1609061167
WEBSTER, MARILYN S MD
HATTIESBURG
MS
09775591
1184603011
WEBSTER, STEVAN A MD
SOUTHAVEN
MS
00123065
1841213931
WEDDLE, RICHARD E MD
JACKSON
MS
00880005
1972583524
WEEDEN, MICHAEL L OD
CORINTH
MS
02420704
1134330822
WEEKS JR, ERNEST S MD
FLOWOOD
MS
03135377
1851454177
WEEKS, AMANDA M FNP
TUPELO
MS
09701311
1346504768
WEEKS, ANDREW Q MD
JACKSON
MS
00282801
1588879811
WEEKS, BARRY L DMD
WATER VALLEY
MS
06277746
1548285968
WEEKS, DAVID C MD
GULFPORT
MS
09158031
1801099130
WEEKS, JAMES K MD
SOUTHAVEN
MS
00019225
1760427090
WEEKS, THOMAS L MD
VICKSBURG
MS
00660430
1962422402
WEEMS, MARK A
GREENWOOD
MS
00119623
1578592226
WEGENER, ERIC E MD
FLOWOOD
MS
00537741
1851528764
WEI, XIN MD
TUPELO
MS
00119477
1568419513
WEIBLE, NANCY
HATTIESBURG
MS
00114167
1700821931
WEILAND, GERI L MD
VICKSBURG
MS
00120829
1093735466
WEINER, ROGER D MD
CLARKSDALE
MS
04021063
1285834804
WEINLEIN, IV, JOHN C MD
SOUTHAVEN
MS
03209075
1407090129
WEIRICH, ERIC M MD
OLIVE BRANCH
MS
00113691
1073555660
WEISENBERGER, SARA J
JACKSON
MS
00116007
1598715393
WEISS JR, RAYMOND L MD
OCEAN SPRINGS
MS
00118558
1851431159
WEISS, DAVID I MD
HATTIESBURG
MS
00115745
1366473530
WELCH, BERT A
FLOWOOD
MS
333
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
09520871
1891847521
WELCH, BETSY R
FLOWOOD
MS
06175811
1629355342
WELCH, BRANDY C FNP
BOLTON
MS
08959866
1588119176
WELCH, ELIZABETH D NP
LAUREL
MS
00116486
1972694818
WELCH, IRMA H MD
JACKSON
MS
05107231
1558373530
WELCH, JERRY W MD
LAUREL
MS
09979868
1205947652
WELCH, PAUL B MD
JACKSON
MS
06703542
1629136825
WELCH, WILLIAM C
JACKSON
MS
05100254
1740210699
WELCH, WILLIAM P MD
JACKSON
MS
00014862
1538210737
WELDON, JOHN S MD
PASCAGOULA
MS
08733811
1003907460
WELDON, PATRICK E MD
JACKSON
MS
00019972
1215929104
WELDON, THOMAS E MD
GREENWOOD
MS
01057053
1841365152
WELLS, CATHERINE RN
JACKSON
MS
04802528
1326438706
WELLS, CHANNING K OD
JACKSON
MS
03479057
1477568749
WELLS, FORREST S
OCEAN SPRINGS
MS
06927265
1144517822
WELLS, JEREMY B MD
HATTIESBURG
MS
05838340
1053598433
WELLS, LESLIE R DMD
NEW AUGUSTA
MS
08156515
1497112403
WELLS, MERRY C CNP
HATTIESBURG
MS
00114187
1710001482
WELLS, PEGGY J MD
CLARKSDALE
MS
00115210
1265439228
WELLS, RALPH P
JACKSON
MS
08135221
1285865162
WELLS, RICHARD E MD
JACKSON
MS
00125175
1477580819
WELLS, TABITHA NP
JACKSON
MS
00121511
1841315678
WELLS, WILLIE L MD
BRUCE
MS
08478874
1114089372
WEN, TONY S MD
JACKSON
MS
00122948
1104925882
WENDER, DAVID F MD
FLOWOOD
MS
03003072
1407244395
WENDLING, JAMIE L NP
GULFPORT
MS
02034063
1013170653
WENSTROM, WILLIAM J
OCEAN SPRINGS
MS
04937550
1518999630
WENZLER, ROBERT J DPM
SOUTHAVEN
MS
00956270
1447412945
WERTHEIMER, MICHAEL L MD
SOUTHAVEN
MS
334
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00017339
1225040819
WESSLER, ROBERT C MD
GULFPORT
MS
00126493
1427051267
WESSON, MATTHEW B MD
TUPELO
MS
00126769
1346285491
WEST, BOBBIE B MD
BRANDON
MS
00019567
1538276191
WEST, FLAVIA H MD
PONTOTOC
MS
00120874
1467596155
WEST, FREDERICK M MD
JACKSON
MS
08956501
1053752642
WEST, GRIFFIN H DMD
JACKSON
MS
00016271
1306823117
WEST, JAMES M MD
OLIVE BRANCH
MS
05021312
1174539753
WEST, WILLIAM F DMD
TUPELO
MS
00018913
1073507083
WESTBROOK, DAVID MD
JACKSON
MS
00114381
1225043599
WESTBROOK, HOWARD G
OCEAN SPRINGS
MS
00087104
1245448760
WESTBROOK, JAMES D OD
PICAYUNE
MS
07655571
1285738468
WESTBROOK, TOIKUS Z MD
OXFORD
MS
07524391
1740290048
WESTERVELT, CHRISTOPHER L MD
HATTIESBURG
MS
05384868
1679748016
WESTERVELT, JUSTIN D MD
HATTIESBURG
MS
05873761
1003076647
WETZEL, MISTY T MD
HATTIESBURG
MS
02479740
1013179266
WETZEL, RAUN J MD
GULFPORT
MS
03584804
1316070899
WHARTON, MARIANNE D NP
BATESVILLE
MS
05521513
1184988594
WHATLEY, JAMES Z MD
JACKSON
MS
00114637
1487697561
WHEAT, DAVID B MD
CLINTON
MS
00124043
1902972235
WHEATON, MYRA A MD
HOLLY SPRINGS
MS
00017463
1750346946
WHEELER, BRENT R M.D.
HATTIESBURG
MS
00660104
1639213275
WHEELER, EDWARD S DMD
GULFPORT
MS
06785238
1730270786
WHEELER, HAROLD J MD
GREENWOOD
MS
07304246
1477957132
WHEELER, ROBYN NP
GULFPORT
MS
07720250
1639243835
WHEELER, SANDRA L CFNP
RIPLEY
MS
03873227
1023338183
WHELAN, JACOB R MD
OXFORD
MS
03507811
1730568692
WHIDDON, AMANDA C CNP
HATTIESBURG
MS
00983586
1457513350
WHIPPLE, PATRICK D
JACKSON
MS
335
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
07108223
1326461500
WHITACRE, JEANA NP
WEST POINT
MS
00087047
1235212457
WHITAKER, DICK S OD
WOODVILLE
MS
00011233
1053349373
WHITAKER, MURRAY P MD
VICKSBURG
MS
00116627
1215904644
WHITE III, MARSHALL N MD
PASCAGOULA
MS
00124378
1457364606
WHITE JR, JOHN W MD
TUPELO
MS
01320548
1013261619
WHITE, ALFE NP-C
FLOWOOD
MS
06377843
1801244702
WHITE, AMBER B NP
JACKSON
MS
00010900
1144244286
WHITE, CHESTER K MD
TUPELO
MS
00112141
1376671255
WHITE, CLINTON B MD
HATTIESBURG
MS
05233201
1063521292
WHITE, DEANNA R MD
TUPELO
MS
06986397
1184668584
WHITE, ELIZABETH NP
HATTIESBURG
MS
00532055
1114310877
WHITE, ELIZABETH H NP
PONOTOC
MS
03739577
1407207640
WHITE, HANNAH N NP
JACKSON
MS
07101074
1811954324
WHITE, IV, ELBERT A MD
TUPELO
MS
00010587
1457350282
WHITE, JAMES L MD
TUPELO
MS
09507716
1376819748
WHITE, JANAE H NP
CANTON
MS
00118508
1033204383
WHITE, JOLYNN CFNP
WEST
MS
00115411
1144261793
WHITE, JOSEPH MD
BROOKHAVEN
MS
00011930
1760559751
WHITE, JR., ALLISON R MD
GREENWOOD
MS
02520744
1376670570
WHITE, KALA N
COLUMBUS
MS
00434388
1558437830
WHITE, LEIGH DPM
MERIDIAN
MS
00984375
1194825216
WHITE, PAIGE C MD
JACKSON
MS
09055744
1326400425
WHITE, PARKER A MD
JACKSON
MS
00111534
1659370229
WHITE, PATRICIA A CFNP
CLARKSDALE
MS
00660213
1255499869
WHITE, SONYA F DDS
MOSS POINT
MS
02875352
1508866799
WHITE, TARA C CFNP
GULFPORT
MS
03480297
1053666503
WHITE, VALERIE M CFNP
FAYETTE
MS
00118261
1700936002
WHITECAR JR, JOHN P MD
COLUMBUS
MS
336
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
06986769
1043616543
WHITEHEAD, ALYSSA C NP
LOUISVILLE
MS
05925345
1720430572
WHITEHEAD, JONATHAN B NP-C
LAUREL
MS
00123659
1215933924
WHITEHEAD, KARY G MD
MERIDIAN
MS
07734222
1700057106
WHITEHEAD, KRISTOPHER W MD
TUPELO
MS
06475799
1750653382
WHITEHEAD, LES S NP-C
BROOKHAVEN
MS
00123887
1962512525
WHITEHEAD, RAYMOND MD
HATTIESBURG
MS
00019870
1871603688
WHITEHEAD, WILLIAM A MD
HATTIESBURG
MS
07837508
1285741884
WHITEHURST, ANGIE M NP
IUKA
MS
00121854
1689622318
WHITEHURST, ANNE B
JACKSON
MS
09173056
1114187515
WHITES, DAYTON E MD
LUCEDALE
MS
00060236
1326184110
WHITES, PERRY M DMD
GREENWOOD
MS
00201796
1831149947
WHITFIELD, CARLA M FNP
COLUMBIA
MS
00660227
1073601407
WHITFIELD-LUCAS, ALVERNICA DDS
PASCAGOULA
MS
04930704
1073883203
WHITING, CLYDE T MD
CLEVELAND
MS
01656530
1093721037
WHITLEY, DEAN E RN
MADISON
MS
00660232
1013921998
WHITLOCK JR, ACIE DMD
JACKSON
MS
00122738
1598797870
WHITLOCK, RICHARD S
MOSS POINT
MS
01409841
1063866937
WHITMAN, NICOLE NP
BILOXI
MS
02137226
1003107194
WHITNEY, KAREN M FNP
WHITFIELD
MS
08477366
1164454088
WHITNEY, KEYNA J MD
NATCHEZ
MS
02750798
1508029695
WHITSON, NICOLE J FNP
HATTIESBURG
MS
00125376
1659376382
WHITTINGTON, CURTIS D MD
JACKSON
MS
00120574
1942384607
WHITTINGTON, HELEN C CFNP
MCCOMB
MS
00113908
1679514863
WHITTINGTON, KENNETH J MD
HAZLEHURST
MS
08837834
1265569321
WHITTINGTON, LAURA M CRNA
LAUREL
MS
00125793
1780794594
WHITTINGTON, MATTHEW C
HATTIESBURG
MS
00584811
1598061921
WHITTINGTON, SHANNON N NP
HATTIESBURG
MS
00110765
1710974605
WHITTLE, ALLISON P MD
SOUTHAVEN
MS
337
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00113076
1588621064
WHITTLE, TIMOTHY E MD
WEST POINT
MS
05025853
1437121134
WICHMAN, NEVILLE R MD
JACKSON
MS
00175551
1417368242
WIDDOWS, CHRISTIAN M MD
JACKSON
MS
01437504
1356558357
WIENER, HILLEL E DO
HERNANDO
MS
00118866
1265409478
WIERZBICKA, GRAZYNA MD
PASCAGOULA
MS
00013593
1407881022
WIGGINS, CHRIS E MD
PASCAGOULA
MS
08954379
1588015341
WIGGINS, KYLE R DMD
CHARLESTON
MS
02221339
1497089197
WIGGINS, SHENEKIA A DMD
JACKSON
MS
07973018
1538152756
WIGGINTON, JIMMY FNP
CORINTH
MS
00124445
1366585143
WIGGS, CHRISTOPHER D
FLOWOOD
MS
04887214
1316196850
WIJEWARDANE, JOHNNIE SUE C FNP
FLOWOOD
MS
01476719
1295139046
WIKLE, JOHN C DMD
MAGEE
MS
03200304
1174870802
WILBANKS, ELIZABETH B PNP-C
CORINTH
MS
00125561
1730148123
WILBON, ROSIE A NP
MACON
MS
04520877
1063676690
WILBOURN, RANCE B MD
CORINTH
MS
07059260
1518018126
WILBOURNE, LESLEIGH CFNP
JACKSON
MS
09521395
1275858599
WILBURN, CATHY
OXFORD
MS
00123653
1275538761
WILCOX, WILLIAM P MD
MERIDIAN
MS
01733887
1003921172
WILDE JR, JAMES O MD
CHARLESTON
MS
03137731
1295893196
WILDE, SPENCER K DDS
JACKSON
MS
01756728
1477712990
WILDER, LATONYA MD
GULFPORT
MS
07084719
1427460849
WILE, ANNA A MD
JACKSON
MS
00012528
1922035120
WILEY JR, THOMAS L MD
JACKSON
MS
06559092
1083841712
WILEY, DANDRIA T FNP
GULFPORT
MS
00272896
1992750780
WILEY, MARK OD
RICHLAND
MS
03981524
1437237732
WILHELM, ANDREW M DO
JACKSON
MS
03309314
1154529709
WILHELM, CHELLE R MD
JACKSON
MS
03932074
1154360824
WILKAITIS, JOHN E MD
JACKSON
MS
338
3:19:30 PM
Envision
Mississippi Division of Medicaid
Provider Subsystem
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04883219
1245212844
WILKERSON, BOBBY S MD
JACKSON
MS
02503257
1295106326
WILKERSON, CONSTANCE D FNP
CARTHAGE
MS
01408802
1689758385
WILKERSON, GEORGE
ELLISVILLE
MS
04375374
1790166841
WILKERSON, STEPHEN C
TUPELO
MS
05938350
1790166841
WILKERSON, STEPHEN C DO
IUKA
MS
06454351
1982080602
WILKES, ALISHA B NP
RIDGELAND
MS
05632706
1114246147
WILKEY, HEATHER H FNP
GREENWOOD
MS
00115183
1598875304
WILKINS, ROBERT G MD
HATTIESBURG
MS
00121583
1942300959
WILKINSON, BRIAN L MD
MERIDIAN
MS
01555860
1215347315
WILKINSON, JAMES DO
WAYNESBORO
MS
09905816
1639481856
WILKINSON, KELLY J MD
JACKSON
MS
07657790
1972596567
WILLBRANDT, BARRY W MD
GULFPORT
MS
00060007
1548343148
WILLIAM W WOODS III DMD PLLC
MERIDIAN
MS
00152049
1922066083
WILLIAMS II, WESLEY C MD
BOONEVILLE
MS
02582868
1760564660
WILLIAMS JR, WILLIAM T MD
JACKSON
MS
00017598
1215951439
WILLIAMS, ALAN T MD
COLUMBUS
MS
00011851
1568431963
WILLIAMS, ALBERT T
JACKSON
MS
02008257
1184019655
WILLIAMS, ALISON F MD
JACKSON
MS
00087064
1669524278
WILLIAMS, ANN OD
HATTIESBURG
MS
00660353
1720098908
WILLIAMS, BRADLEY E DMD
PELAHATCHIE
MS
02657514
1760841142
WILLIAMS, BRANDI E CNP
HATTIESBURG
MS
00120926
1669484655
WILLIAMS, BRIAN K M.D.
RICHLAND
MS
05079294
1174557466
WILLIAMS, CAREY C DPM
OXFORD
MS
07187347
1295035962
WILLIAMS, CHRISTINA S FNP
CORINTH
MS
00114614
1538257654
WILLIAMS, CLIFTON
MCCOMB
MS
06506735
1750735452
WILLIAMS, CONNIE R NP
JACKSON
MS
00125405
1972546901
WILLIAMS, DANURIUS L MD
JACKSON
MS
00014461
1285677310
WILLIAMS, DAVID J MD
NEW ALBANY
MS
339
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
02326761
1205844537
WILLIAMS, ELIZABETH FNP
JACKSON
MS
00124347
1588623292
WILLIAMS, ERNEST Q MD
OXFORD
MS
07058811
1538246632
WILLIAMS, FELECIA P CFNP
GREENVILLE
MS
03555274
1316352933
WILLIAMS, GISELA K
TUPELO
MS
00124148
1447324272
WILLIAMS, GWENDOLYN M FNP,
GREENVILLE
MS
07336564
1194108811
WILLIAMS, IESHA R NP
JACKSON
MS
00124293
1780657056
WILLIAMS, J BARTON MD
COLUMBUS
MS
07374200
1144452293
WILLIAMS, JAMES F DMD
JACKSON
MS
09700008
1578760534
WILLIAMS, JANE-CLAIRE B MD
FLOWOOD
MS
06551373
1568424851
WILLIAMS, JASON A MD
OCEAN SPRINGS
MS
01451753
1598029068
WILLIAMS, JASON H MD
JACKSON
MS
00122790
1134239940
WILLIAMS, JEFFREY C
HATTIESBURG
MS
03132872
1811338072
WILLIAMS, JENNIFER P FNPC
NATCHEZ
MS
05554263
1972997203
WILLIAMS, JENNIFER P MD
JACKSON
MS
05657777
1477923241
WILLIAMS, JESSE J CFNP
GREENVILLE
MS
09678304
1255567251
WILLIAMS, JONATHAN C DO
STARKVILLE
MS
02055216
1104024769
WILLIAMS, JOSHUA C MD
JACKSON
MS
00124453
1154318947
WILLIAMS, KEITH D MD
SOUTHAVEN
MS
00011155
1851480974
WILLIAMS, KENNETH MD
HOLLY SPRINGS
MS
07782252
1235107004
WILLIAMS, KIMBERLY M CNM
MERIDIAN
MS
02277744
1649620485
WILLIAMS, LOREN W FNP
BROOKHAVEN
MS
00114438
1144297755
WILLIAMS, LUELLA A
PASS CHRISTIAN
MS
05857761
1144609926
WILLIAMS, MADISON H MD
JACKSON
MS
00123514
1073550273
WILLIAMS, MARIE J NP
JACKSON
MS
01582712
1043468234
WILLIAMS, MARILYN D CFNP
GREENVILLE
MS
01356261
1184806150
WILLIAMS, MARY A FNP
CLARKSDALE
MS
05209802
1528298189
WILLIAMS, MATTHEW D MD
COLUMBUS
MS
05078778
1245788504
WILLIAMS, MELISSA D NP
OXFORD
MS
340
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
05480550
1811050594
WILLIAMS, MHEJA M MD
CANTON
MS
04273311
1013105451
WILLIAMS, MICHAEL O DDS
GULFPORT
MS
08221076
1861436990
WILLIAMS, MICHAEL R NP
VICKSBURG
MS
02282768
1316346992
WILLIAMS, MITCHELL R FNP
PLANTERSVILLE
MS
08001341
1962875575
WILLIAMS, MONICA NP
GREENWOOD
MS
04258064
1861886491
WILLIAMS, PAUL W MD
JACKSON
MS
00880081
1912120080
WILLIAMS, PHILLIP A OD
CORINTH
MS
00014620
1053307256
WILLIAMS, RALPH E MD
HOUSTON
MS
02420261
1124484647
WILLIAMS, RAMONA L FNP-C
OCEAN SPRINGS
MS
01870013
1821034596
WILLIAMS, REX B MD
JACKSON
MS
00856316
1841319308
WILLIAMS, RICHARD A DMD
RULEVILLE
MS
00114465
1407825987
WILLIAMS, ROBERT J NP
CLINTON
MS
03737063
1376839431
WILLIAMS, ROBERT M
OCEAN SPRINGS
MS
00120454
1568572709
WILLIAMS, ROGER A MD
TUPELO
MS
04226399
1902829872
WILLIAMS, RONALD B MD
FLOWOOD
MS
07371837
1306225198
WILLIAMS, RYAN A MD
JACKSON
MS
05454895
1598097883
WILLIAMS, SARAH E MD
VICKSBURG
MS
09126533
1245603844
WILLIAMS, SHANTRICE NP
JACKSON
MS
02822330
1851648802
WILLIAMS, SHERRA J FNP
JACKSON
MS
07020313
1811221401
WILLIAMS, SHONDA NP
CLEVELAND
MS
06375241
1114377298
WILLIAMS, SUSAN F
TUPELO
MS
03053236
1437485323
WILLIAMS, SYLVIA K NP
MERIDIAN
MS
00384560
1588007488
WILLIAMS, THERON S MD
SOUTHAVEN
MS
01925741
1174787915
WILLIAMS, TRACY L DMD
LAUREL
MS
04971805
1720212350
WILLIAMS, WANDA L MD
JACKSON
MS
06184861
1467446963
WILLIAMS, WENDY E MD
BILOXI
MS
05658551
1700274016
WILLIAMS-DAVIS, CHRYSTAL F FNP
BYHALIA
MS
05237351
1023429941
WILLIAMSON JR, THOMAS C MD
JACKSON
MS
341
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08879248
1285172619
WILLIAMSON, ADRIANNA G CNP
HATTIESBURG
MS
00018567
1780777847
WILLIAMSON, AUBREY D MD
JACKSON
MS
00116129
1700869989
WILLIAMSON, CATHY G
MERIDIAN
MS
02756529
1740568443
WILLIAMSON, ELLA M NP
TUPELO
MS
08637868
1578915492
WILLIAMSON, HOYT A FNP
LEAKESVILLE
MS
00115372
1346211596
WILLIAMSON, JOHNNIE W
TUPELO
MS
07487523
1285024950
WILLIAMSON, MCKENZIE W NP
OXFORD
MS
03925360
1881778629
WILLIAMSON, MELANIE J
BILOXI
MS
09552566
1679585673
WILLIAMSON, NATHAN A MD
LAUREL
MS
00012634
1487762001
WILLIAMSON, STONEY MD
HATTIESBURG
MS
00116831
1710989678
WILLIAMSON, TERESA A MD
PASCAGOULA
MS
00124312
1881702447
WILLIAMSON, TODD D DO
HATTIESBURG
MS
00783551
1407136708
WILLIFORD, NANCY J CFNP
RIDGELAND
MS
06957085
1134171895
WILLINGHAM, CYNTHIA A MD
GREENWOOD
MS
00076741
1598116402
WILLIS, BRITTANY H FNP
PONTOTOC
MS
09758517
1649429119
WILLIS, DAWNA J APN
OLIVE BRANCH
MS
02727050
1497794259
WILLIS, EDWARD R MD
BAY ST LOUIS
MS
00117492
1336171511
WILLIS, GREGG A MD
TUPELO
MS
00114279
1639100340
WILLIS, JEFFERY T M.D.
PHILADELPHIA
MS
04350504
1013016104
WILLIS, SHELDON DDS
FLOWOOD
MS
07628760
1306873732
WILLIS, TANYA
JACKSON
MS
01082264
1861464760
WILLIS, TURNER
MCCOMB
MS
00113996
1346286598
WILLIS, WALTER L MD
PHILADELPHIA
MS
08203591
1689781619
WILLISTON, PAUL M OD
GULFPORT
MS
08623511
1578523981
WILLS, THOMAS E MD
CENTREVILLE
MS
07629527
1619975521
WILSON JR, PASCHAL P MD
OXFORD
MS
06207340
1346354081
WILSON JR, WOODIE J MD
HATTIESBURG
MS
00126868
1104823202
WILSON, CHARLES E
IUKA
MS
342
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00123305
1558311431
WILSON, CHARLES J MD
OCEAN SPRINGS
MS
05529352
1760786479
WILSON, CRYSTAL R FNP
IUKA
MS
05736374
1457896417
WILSON, DOROTHY NP
TUPELO
MS
00120383
1336177021
WILSON, FELISA D
JACKSON
MS
00013383
1043311483
WILSON, JAMES P MD
MERIDIAN
MS
07052201
1316321730
WILSON, JASON A O.D.
LONG BEACH
MS
03158779
1508126921
WILSON, JOI V MD
SOUTHAVEN
MS
07825301
1881738532
WILSON, JONATHAN W OD
SOUTHAVEN
MS
00010895
1568560530
WILSON, JOSEPH L MD
VICKSBURG
MS
03020821
1255874368
WILSON, JOSHUA H OD
JACKSON
MS
08652362
1376792192
WILSON, KRISTIN M APRN
SOUTHAVEN
MS
04882001
1427174143
WILSON, LARRY J DMD
ROLLING FORK
MS
07929573
1437477163
WILSON, LEIGH A NP
HATTIESBURG
MS
00118644
1184612368
WILSON, MARK E MD
FLOWOOD
MS
09437721
1396090163
WILSON, MARY KATHRYN OD
GREENWOOD
MS
03857849
1093790032
WILSON, MICHAEL A MD
MCCOMB
MS
00125696
1447251632
WILSON, PAMELA K
CLARKSDALE
MS
00060189
1326153982
WILSON, RAMSEY E DMD
COLLINS
MS
00123660
1225034655
WILSON, RHONDA H MD
MERIDIAN
MS
00783848
1447503396
WILSON, RYAN
SOUTHAVEN
MS
05051897
1427091891
WILSON, SANDRA R FNP
WHITFIELD
MS
07900514
1619346822
WILSON, SHUNDRA U NP
JACKSON
MS
02229351
1093859563
WILSON, SIDNEY M O.D.
JACKSON
MS
06758720
1437579091
WILSON, STEPHANIE L NP
BAY SAINT LOUIS
MS
04671271
1104243831
WILSON, TANYANEKA L FNP
MERIDIAN
MS
00110402
1386777589
WILSON, YOLANDA W M.D.
RIDGELAND
MS
00114165
1326079518
WINDHAM, ALFRED G M.D.
VICKSBURG
MS
08952891
1477621324
WINDHAM, BEVERLY G MD
JACKSON
MS
343
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00114640
1649380940
WINDHAM, BILLY R FNP
HATTIESBURG
MS
08835763
1497975106
WINDHAM, BYRON P MD
OXFORD
MS
04321853
1477824902
WINDHAM, CHELSEY E NP-C
BILOXI
MS
08621557
1811309040
WINDHAM, SYLVIA M CNM
MAGEE
MS
00015663
1710999271
WINDHAM, THOMAS L MD
BATESVILLE
MS
03273011
1861832289
WINDHAM, WILLIAM J MD
JACKSON
MS
02435291
1760690713
WINEMAN, ROBERT W MD
JACKSON
MS
00115566
1962754473
WINFIELD, KAREN L
JACKSON
MS
05504062
1467600817
WINFIELD, TAMARA C DO
JACKSON
MS
04271891
1740308055
WINFORD, STACEY D DMD
YAZOO CITY
MS
00660217
1407979107
WINFORD-COLLIER, EVELYN L DMD
BILOXI
MS
01003099
1073533782
WINGATE, TIFFANY T NP
MERIDIAN
MS
06375287
1962494294
WINGFIELD, ANGELA B MD
GULFPORT
MS
05376221
1134552078
WINGO, SYLVIA MD
BRANDON
MS
00112103
1740373448
WINKELMANN, MICHAEL H MD
FLOWOOD
MS
00660177
1023102274
WINN III, EUSTACE H DMD
GREENVILLE
MS
00125909
1083647879
WINNIFORD, MICHAEL
JACKSON
MS
07407323
1124113667
WINSCOTT, JOHN G MD
JACKSON
MS
07076836
1881038479
WINTER, LAURA MD
MERIDIAN
MS
06730519
1932397908
WINTER, VANESSA E FNP
TUPELO
MS
00117284
1093733172
WINTERS, CHARLES J MD
VANCLEAVE
MS
00660363
1346267242
WINTERS, KIMBERLY V DMD
VICKSBURG
MS
09956787
1265719959
WISE, DIXON J DMD
LAUREL
MS
07108208
1790759579
WISE, TERRENCE R MD
TUPELO
MS
00114188
1871690263
WISEMAN, RICHARD G NP
HOLLY SPRINGS
MS
00123842
1134192594
WISER, ELDRED J
HATTIESBURG
MS
00126975
1932135522
WITCHER, JOHN E MD
KOSCIUSKO
MS
04980247
1407260177
WITHANE, NISHA S MD
JACKSON
MS
344
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
01731372
1295815462
WITHERS, JAMES J MD
KOSCIUSKO
MS
08789833
1659307247
WITMER, LORI K APN
HORN LAKE
MS
06252590
1386840619
WITT, AMANDA L MD
JACKSON
MS
09584741
1104012566
WITTERSHEIM, DANIEL A MD
VANCLEAVE
MS
00019353
1679690523
WITTY JR, JOSEPH B MD
COLUMBUS
MS
00113652
1114984374
WITTY, DAVID H MD
TUPELO
MS
03539551
1578904686
WITTY, NILDA M MD
JACKSON
MS
00588235
1992035000
WIYGUL, KATHRYN K CPNP
OXFORD
MS
08308391
1174807135
WIYGUL, RYAN C CFNP
TUPELO
MS
06101246
1255625463
WOFFORD III, JOHN D MD
JACKSON
MS
00010735
1255341525
WOFFORD JR, JOHN W
JACKSON
MS
00116903
1720013428
WOFFORD, MARION R
JACKSON
MS
00124238
1114983111
WOLFE JR, KENNETH A MD
SALTILLO
MS
00117309
1861411621
WOLFE, DOUGLAS A MD
JACKSON
MS
06277345
1093791220
WOLFE, JIMMY V MD
JACKSON
MS
00123676
1740324698
WOLFE, JR., BOBBY MD
PEARL
MS
08653225
1669584082
WOLFE, LEIGH NP
NATCHEZ
MS
00060119
1134349160
WOLFE, LLOYD B DMD
JACKSON
MS
07037821
1740215797
WOLFE, SCOTT J MD
NATCHEZ
MS
00010644
1073629739
WOLFE, WALTER R MD
JACKSON
MS
07878359
1811084171
WOLFSON, ERIC H M.D.
GULFPORT
MS
00584221
1619919305
WOLLAK, ISTVAN D MD
SOUTHAVEN
MS
00126773
1982638110
WOMACK, BRADLEY G MD
TUPELO
MS
09457727
1669667572
WONG, AURORA MD
TUPELO
MS
00087810
1376637405
WONG, BRUNSWICK R OD
GREENVILLE
MS
06082713
1487852091
WOO, MACK D MD
JACKSON
MS
00018806
1699718981
WOOD III, ARTHUR E MD
WAYNESBORO
MS
05487548
1275762320
WOOD, ARTHUR E MD
RIPLEY
MS
345
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00125856
1285785931
WOOD, DUKE J DO
AMORY
MS
01124565
1871501056
WOOD, EUGENE G MD
FLOWOOD
MS
01278001
1336575315
WOOD, HOLLY B FNP
ECRU
MS
05225301
1235506668
WOOD, LAUREN NP-C
COLUMBUS
MS
03650031
1194165365
WOOD, MICHAEL T MD
JACKSON
MS
00087916
1013030964
WOOD, WILLIAM OD
PONTOTOC
MS
00010725
1134155971
WOODALL, BONNIE N MD
JACKSON
MS
07923258
1083876833
WOODALL, JAMES W MD
JACKSON
MS
08778745
1851755672
WOODALL, TYLER R MD
JACKSON
MS
00116149
1164450730
WOODARD, JAMES S MD
NETTLETON
MS
00011097
1316954225
WOODLIFF, DAN M MD
JACKSON
MS
04106368
1013330299
WOODRUFF, ANNA D FNP-B
TUPELO
MS
00110072
1336220177
WOODRUFF, ROBERT K DPM
JACKSON
MS
04973778
1790879328
WOODS III, WILLIAM C NP
JACKSON
MS
05258855
1376754077
WOODS, AMY R MD
BYHALIA
MS
02003530
1659675064
WOODS, ELISHA D FNP
HATTIESBURG
MS
00660118
1831249929
WOODS, JACKIE R DDS
TYLERTOWN
MS
00064725
1366535338
WOODS, ROGER D DMD
FOREST
MS
05787587
1487072864
WOODS, SHANNON R NP
SOUTHAVEN
MS
08205044
1255538724
WOODS, STANELY M DMD
SARDIS
MS
01750704
1881032951
WOODS, TIFFANY D MD
JACKSON
MS
00660205
1386758829
WOODS, TINA R DMD
JACKSON
MS
00122737
1104852037
WOODS, TRENT A MD
HATTIESBURG
MS
06558368
1184824666
WOODS, WESLEY S DO
TUPELO
MS
09425300
1366644056
WOODSON III, JAMES R DMD
JACKSON
MS
00589022
1831241504
WOODSON, BENJAMIN W MD
COLUMBUS
MS
03320010
1629445879
WOODWARD, FRANCES C NP
JACKSON
MS
00114634
1710912696
WOODWARD, LOUANN H MD
JACKSON
MS
346
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00120455
1730168196
WOODWARD, STEVEN D MD
STARKVILLE
MS
00114996
1649203688
WOODY, WALTER W MD
JACKSON
MS
00328040
1447709498
WOOLDRIDGE, ELIZABETH FNP
HERNANDO
MS
00016236
1518937044
WOOLDRIDGE, THOMAS D MD
TUPELO
MS
00015896
1174577944
WOOLEY, JOHN R MD
JACKSON
MS
09273761
1891082715
WOOLFOLK, JONATHAN A DMD
GRENADA
MS
08704369
1194748251
WOOLRIDGE, DONALD A M.D.
PICAYUNE
MS
00122436
1275557613
WOOTEN, DARWIN B
CORINTH
MS
04181020
1427285055
WOOTEN, MELISSA R CNNP
HATTIESBURG
MS
00116922
1770511420
WOOTEN, WILLIAM MD
VICKSBURG
MS
09552515
1295934115
WORSHAM, CANDACE J DO
GULFPORT
MS
09271711
1396941449
WORTHAM, ANGELA H MD
SOUTHAVEN
MS
08224203
1740651819
WORTHEY, BRENDA E FNP-C
TUPELO
MS
06001526
1558556621
WORTHINGTON, ETHAN B DO
WIGGINS
MS
07133522
1437222015
WORTHINGTON, TIFFANY L DO
WIGGINS
MS
00120290
1871521179
WREN, ANITA D
JACKSON
MS
00117875
1629016126
WREN, CHARLES M DO
CORINTH
MS
06522007
1437557170
WREN, MEREDITH H NP
HATTIESBURG
MS
00115711
1992857106
WRIGHT JR, BENNIE B MD
CLEVELAND
MS
05407034
1073840021
WRIGHT, ALANNA J NP
JACKSON
MS
09925775
1245761360
WRIGHT, CHRISTINE J NP
BILOXI
MS
03558081
1215304696
WRIGHT, CHRISTOPHER NP
COLUMBUS
MS
03808012
1366866154
WRIGHT, COURTNEY C PA-C
JACKSON
MS
08082835
1376955310
WRIGHT, CRYSTAL M MD
JACKSON
MS
00115718
1417945668
WRIGHT, CYNTHIA H M.D.
FLOWOOD
MS
00325262
1649694183
WRIGHT, DENISE M CNP
GREENVILLE
MS
00125958
1376609651
WRIGHT, DENNIS I M.D.
TUPELO
MS
00118692
1053390781
WRIGHT, JAMES C DO
GREENVILLE
MS
347
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00087912
1538290317
WRIGHT, JR, FRANK R OD
RIDGELAND
MS
04507763
1932589058
WRIGHT, KATHRYN C FNP
MANTACHIE
MS
00112655
1982690061
WRIGHT, LINDA D
CLARKSDALE
MS
05325072
1023469244
WRIGHT, MICHELLE N NP
GULFPORT
MS
00676727
1548672868
WRIGHT, NATHANIEL H MD
JACKSON
MS
03331213
1255527743
WRIGHT, PATRICK B MD
JACKSON
MS
00121760
1417913120
WRIGHT, PHYLLIS R
HOLLY SPRINGS
MS
00535845
1750731741
WRIGHT, REBECCA N DMD
NEW ALBANY
MS
03254374
1093190357
WRIGHT, VIRGINIA H MD
JACKSON
MS
06522755
1841602778
WRIGHT, VIRGINIA S MD
JACKSON
MS
07222517
1942464755
WROTEN JR, JAMES E FNP
MEADVILLE
MS
06002852
1558764738
WROTEN, LORI L FNP
MEADVILLE
MS
07988561
1104030923
WU, DANIEL S MD
JACKSON
MS
03673557
1205034840
WURM, WILLIAM V MD
OCEAN SPRINGS
MS
02189837
1528257250
WYATT, ALISHA N MD
GULFPORT
MS
09409379
1861613077
WYATT, CHRISTOPHER H
JACKSON
MS
08655862
1053532226
WYATT, JULIE P MD
JACKSON
MS
09421887
1053639088
WYLIE, HART K NP
JACKSON
MS
06677827
1184793531
WYNN, ANDREW J MD
OXFORD
MS
01475071
1801250626
WYNN, CARRIE S MD
JACKSON
MS
07888702
1568573228
WYNN, JAMES J MD
JACKSON
MS
00117314
1265477459
YABLON, STUART A MD
JACKSON
MS
01386537
1801153705
YAHYA, FAZAL MD
TUPELO
MS
02572766
1336302819
YAMOUT, ADAM N DO
MERIDIAN
MS
08737741
1811158587
YAN, BENJAMIN MD
GULFPORT
MS
07121037
1528370749
YANES CARDOZO, LICY L MD
JACKSON
MS
00124369
1568537025
YANEZ, DIMITRI A MD
BAY ST LOUIS
MS
01787021
1710253877
YARBER, CARLEY B CPNP
ELLISVILLE
MS
348
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
00122224
1447261268
YARBER, ROBERT H MD
TUPELO
MS
00082880
1588694806
YARBOROUGH, MICHAEL J MD
BILOXI
MS
00121418
1265455802
YARBROUGH, BENJAMIN O MD
MEADVILLE
MS
00660187
1760601041
YARBROUGH, STEVEN C DMD
LOUISVILLE
MS
00113947
1245318732
YARLAGADDA, DURGA P
OCEAN SPRINGS
MS
00017885
1437195633
YATES, ANNE B
JACKSON
MS
00701371
1629449798
YATES, MARY R NP
TUPELO
MS
01577369
1003853045
YATES, TRAVIS
UNIVERSITY
MS
00056261
1760884373
YAWN, AMANDA C NP
GULFPORT
MS
00114728
1588632467
YEAGER, DOUGLAS L MD
JACKSON
MS
04174341
1427076595
YEARWOOD, THOMAS L MD
PASCAGOULA
MS
04436509
1407297294
YEATES, CARLA W DMD
ELLISVILLE
MS
07935349
1649595117
YEKAITIS, KEVIN F FNP
SOUTHAVEN
MS
00115167
1295834166
YELVERTON JR, RICHARD L MD
JACKSON
MS
01659312
1780050013
YELVERTON, ANGELIA J NP
JACKSON
MS
05103371
1538246921
YELVERTON, BENJAMIN M PA
HATTIESBURG
MS
08987742
1295105278
YELVERTON, CARLY S PA-C
JACKSON
MS
00060018
1124232806
YELVERTON, JAMES E DMD
SEBASTOPOL
MS
00115594
1992804835
YELVERTON, RICHARD L MD
FLOWOOD
MS
09687217
1558640813
YERGAW, DANIEL A MD
MCCOMB
MS
00014514
1831105980
YOE, WILLIAM E MD
HATTIESBURG
MS
06677512
1689951774
YORK, ALICIA B FNP
SOUTHAVEN
MS
00660133
1417045386
YORK, BENNETT V DDS
HATTIESBURG
MS
06008872
1497730469
YORK, JAMES A MD
BAY SPRINGS
MS
07189228
1700034451
YOUNG GAYLOR, LAFARRA D MD
JACKSON
MS
02670814
1609199629
YOUNG, BRANDON L
TUPELO
MS
00064771
1558488841
YOUNG, CHARLES F DMD
TUPELO
MS
01157581
1487693024
YOUNG, CHERYL K NP
TUPELO
MS
349
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
08902542
1902264179
YOUNG, DANIELLE J PA
TUPELO
MS
00119854
1366487365
YOUNG, DAVID R MD
JACKSON
MS
02850701
1619165560
YOUNG, EMILEE C NP
NEW ALBANY
MS
05933790
1952339335
YOUNG, GERALDINE Q NP
JACKSON
MS
02024361
1508224775
YOUNG, JORDAN W PA
OXFORD
MS
07906079
1245433879
YOUNG, KEVIN M MD
FLOWOOD
MS
00015034
1124184031
YOUNG, MOSES C
NATCHEZ
MS
00835093
1124298849
YOUNG, REGINA M GNPBC
IUKA
MS
00116465
1295706455
YOUNG, RONALD A
TUPELO
MS
00123315
1639107147
YOUNG, RONALD S MD
HATTIESBURG
MS
00125697
1013911668
YOUNG, TAMMY H MD
JACKSON
MS
07439241
1770946493
YOUNG, THOMAS C MD
JACKSON
MS
00111416
1396832150
YOUNG, WILLIAM D
WAYNESBORO
MS
06509503
1720240039
YOUNGBLOOD, SLOAN C MD
JACKSON
MS
05303743
1083021984
YOUNGER, KATREVIA NP
JACKSON
MS
00660357
1902007701
YOUNGER, MARTHA H DMD
STARKVILLE
MS
05501206
1619018983
YOUNIS, WALID G MD
HATTIESBURG
MS
03572035
1881643088
YOUSUF, SHUJA MD
BRANDON
MS
00117852
1467462879
YOUSUF, TAUQEER MD
JACKSON
MS
07726353
1497198055
YUAN, JASON Y MD
BOONEVILLE
MS
03078371
1598712994
YUNG, KENNETH A MD
JACKSON
MS
01858208
1407846918
YUVIENCO, JOSE-MARI S MD
HATTIESBURG
MS
08336859
1053601203
ZACHARIAH, PHILIP T MD
COLUMBIA
MS
00117273
1932158482
ZACHARY, DEBORAH FNP
MCCOMB
MS
07728395
1386025336
ZACHARY, TYLER J MD
JACKSON
MS
00012984
1518969724
ZACHOW, STEVEN E
JACKSON
MS
07808893
1598932915
ZAFAR, SALMAN MD
HATTIESBURG
MS
00125085
1871546580
ZAFER, GHANY
OLIVE BRANCH
MS
350
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
PROVIDER NAME
CITY
STATE
04808541
1487063053
ZAKI, MINA DDS
CLARKSDALE
MS
06409263
1821041492
ZAKKAK, THOMAS B DDS
BILOXI
MS
00123480
1215912928
ZALESKI, MICHAEL S DPM
HATTIESBURG
MS
03358532
1215126032
ZAMAN, MOHAMMED N DO
TUPELO
MS
01250304
1336452069
ZAND, KEVIN A MD
JACKSON
MS
00082367
1063472157
ZANONE, MICHAEL T MD
HORN LAKE
MS
00117606
1699790196
ZAYED, MAHMOUD H MD
PASCAGOULA
MS
06870220
1285900563
ZEGARRA, CHRISTIAN MD
JACKSON
MS
00660271
1386729580
ZEHR, DARRELL J DMD
CHOCTAW
MS
02057741
1407087430
ZEID, LOUAY MD
SOUTHAVEN
MS
00433021
1023067360
ZEIDMAN, GLENN E DO
MCCOMB
MS
04650312
1376596932
ZEIN AHMED, MOHAMMED E MD
MERIDIAN
MS
00827374
1013965599
ZEVALLOS, GABRIEL M
MCCOMB
MS
01452591
1336197649
ZEVALLOS, MABEL MD
FLOWOOD
MS
09157552
1548600729
ZHANG, HAOWEI MD
JACKSON
MS
00082852
1497002869
ZHANG, YUAN MD
JACKSON
MS
05377546
1194935510
ZHANG, ZU DONG MD
GREENWOOD
MS
03130304
1881953693
ZHOU, LAN MD
TUPELO
MS
00624361
1407119019
ZHU, RUO P MD
OXFORD
MS
09375701
1316121205
ZIAKAS, GEORGIOS MD
HAZLEHURST
MS
01277278
1124214820
ZIMA, GRETCHEN G MD
JACKSON
MS
03624861
1740471424
ZIMMERMAN, CATHERINE C MD
JACKSON
MS
00111417
1487620597
ZIMMERMAN, JAMES MD
GRENADA
MS
02770819
1588785596
ZOBRIST, STEPHEN M DDS
SUMMIT
MS
06621825
1962631150
ZOGHBY, JONATHAN T MD
OXFORD
MS
09276202
1154669786
ZOLLICOFFER, LAKENDRIA NP
JACKSON
MS
00121166
1104868827
ZOOG, ERIC MD
BRANDON
MS
00114454
1013940766
ZOUBOUKOS, CONSTANTINE P MD
JACKSON
MS
351
3:19:30 PM
Envision
Provider Subsystem
Mississippi Division of Medicaid
PRESCRIBING PROVIDER LISTING
FOR THE STATE OF MISSISSIPPI
Run Date: 6/11/2017
Run Time: 3:19 PM
Report: RP126
Jun 11, 2017
PROVIDER ID
NPI
00064394
00064394
PROVIDER NAME
CITY
STATE
1326197385
DIBERVILLE
MS
1326197385
BILOXI
MS
352
3:19:30 PM