Healthcare Provider Details

I. General information

NPI: 1215502232
Provider Name (Legal Business Name): BLISSFUL NURSING AND MENTAL HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900MS HIGHWAY 15
ACKERMAN MS
39735
US

IV. Provider business mailing address

8900MS HIGHWAY 15
ACKERMAN MS
39735
US

V. Phone/Fax

Practice location:
  • Phone: 662-387-7167
  • Fax:
Mailing address:
  • Phone: 662-387-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YOSHIE LILLEY
Title or Position: OWNER
Credential: FNP-C
Phone: 662-387-7167