Healthcare Provider Details

I. General information

NPI: 1598696924
Provider Name (Legal Business Name): GOSS MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 SUNSET DR STE 104
GRENADA MS
38901-4080
US

IV. Provider business mailing address

1117 SUNSET DR STE 104
GRENADA MS
38901-4080
US

V. Phone/Fax

Practice location:
  • Phone: 662-688-0103
  • Fax: 662-226-3700
Mailing address:
  • Phone: 662-688-0103
  • Fax: 662-226-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PAYTON GOSS
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 662-392-9961