=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770395063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KISMET BEHAVIORAL HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2025
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1410 14TH ST STE A
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39301-4202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 604-481-4821
-----------------------------------------------------
Fax | 601-640-4013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3574
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39303-3574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-481-4821
-----------------------------------------------------
Fax | 601-640-4013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. KATRINA LANDRUM
-----------------------------------------------------
Credential | FPMHNP-BC
-----------------------------------------------------
Telephone | 601-481-4821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------