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General NPI Number Information
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NPI Number | 1962372581
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Entity Type | Individual
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Provider Name | PAYTON GOSS
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Gender | Male
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Dates
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Enumeration Date | 11/08/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 994 BANKHEAD DR
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City | BELZONI
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State | MS
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Zip | 39038-3070
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Country | US
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Telephone | 662-392-9961
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Fax |
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Provider Business Mailing Address
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Address Line | 256 COUNTY ROAD 115
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City | CARROLLTON
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State | MS
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Zip | 38917-6874
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 907944
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License Number State | MS
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