Provider Demographics
NPI:1841864196
Name:BLISSFUL NURSING AND MENTAL HEALTH SERVICES, PC
Entity type:Organization
Organization Name:BLISSFUL NURSING AND MENTAL HEALTH SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:YOSHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, PMHNP-BC
Authorized Official - Phone:623-877-1676
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-0242
Mailing Address - Country:US
Mailing Address - Phone:662-387-7167
Mailing Address - Fax:
Practice Address - Street 1:8900 MS HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-9644
Practice Address - Country:US
Practice Address - Phone:662-387-7167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06681838Medicaid