MEDICARE: KISMET BEHAVIORAL HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1770395063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISMET BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 3574
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39303-3574
Country	:	US
Telephone Number	:	601-481-4821
Fax Number	:	601-640-4013

Provider Business Practice Location Address
First Line	:	1410 14TH ST STE A
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39301-4202
Country	:	US
Telephone Number	:	604-481-4821
Fax Number	:	601-640-4013

Authorized Official
Title or Position	:	CEO
Name	:	MS. KATRINA LANDRUM
Credential	:	FPMHNP-BC
Telephone Number	:	601-481-4821

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	12/12/2025

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