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Tavithia Heidelburg

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

4 Willow Pt Ste 40, Hattiesburg, MS 39402-1150

PECOS Enrollment

Based on the most recent information from CMS, provider Tavithia Heidelburg is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1548768260
Provider Type
Individual
Full Name
Heidelburg, Tavithia
Credential
NURSE PRACTITIONER

Gender
Female
Sole Proprietor
No
Enumeration Date
1/28/2018
Last Updated
5/6/2018

Contact Information

Practice Location

4 Willow Pt Ste 40, Hattiesburg, MS 39402-1150

(601) 336-7253

Unlisted Fax

Mailing Location

4 Willow Pt Ste 40, Hattiesburg, MS 39402-1150

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 902245 Mississippi

Tavithia Heidelburg

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Miller, Jessica Eustis

Hammons, Joshua Cole

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Smith, Jennifer R

Bartran, Lori H.

Leathers, Breanne Nunnally

Hudson, Thomas Neil