Healthcare Provider Details

I. General information

NPI: 1124914981
Provider Name (Legal Business Name): TIFFANY DENNIS APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 HOSPITAL ST
PASCAGOULA MS
39581-5320
US

IV. Provider business mailing address

2815 NINA DR
PICAYUNE MS
39466-4925
US

V. Phone/Fax

Practice location:
  • Phone: 228-283-4140
  • Fax: 228-769-1079
Mailing address:
  • Phone: 601-273-9847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number237412
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number907250
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: