Healthcare Provider Details

I. General information

NPI: 1689046104
Provider Name (Legal Business Name): KRISNA ALYSE HERVEY MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 HERITAGE DR STE 101
OXFORD MS
38655-5571
US

IV. Provider business mailing address

507 HERITAGE DR STE 101
OXFORD MS
38655-5571
US

V. Phone/Fax

Practice location:
  • Phone: 662-638-3388
  • Fax: 866-393-6602
Mailing address:
  • Phone: 662-638-3388
  • Fax: 866-393-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberHERV-LKRQ0I
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: