MRS. LATASHA JACKSON CLAIBORNE PMHNP
NPI 1104104413
Registered Nurse in Vicksburg, MS

Q: What is Latasha Claiborne's NPI number?

The NPI number for Latasha Claiborne is 1104104413. It was assigned to this individual provider in the NPPES registry on August 3, 2011. The provider is also known as Mrs. Latasha Jackson Claiborrne Np.

Q: What is Latasha Claiborne's specialty?

The primary specialty registered for this NPI is Registered Nurse with taxonomy code 163W00000X.

Q: When was this NPI record last updated?

The NPPES record for Latasha Claiborne was last updated on March 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 03, 2011PECOS EnrolledAccepts Medicare Assignment

3444 WISCONSIN AVE, VICKSBURG, MS 39180(601) 638-0031 Get Directions Write a Review

NPPES record last updated: March 17, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 17, 2023, Jan 25, 2023, Jul 27, 2022 and 2 more (5 updates tracked since 2021).

On this page

About Mrs. Latasha Jackson Claiborne Pmhnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. LATASHA JACKSON CLAIBORNE PMHNP (NPI 1104104413) is an individual registered nurse in Vicksburg, Mississippi, licensed in Mississippi (163W00000X) and active in the NPI registry since August 2011. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2007).

NPPES Registry Identity

NPI1104104413

Entity TypeIndividualFemale

Primary Taxonomy163W00000X

Provider Legal NameMRS. LATASHA JACKSON CLAIBORNECredential: PMHNP

Location Address3444 WISCONSIN AVEVicksburg, MS 39180-5331

Mailing Address1701 White StMccomb, MS 39648 · (601) 249-4214 · Fax (601) 249-1062

Phone(601) 638-0031

Sole ProprietorNo

Medical School CMSOtherGraduated 2007

Enumeration DateAugust 3, 2011

Last NPPES UpdateMarch 17, 20235 updates tracked since enumeration

NPPES CertifiedMarch 17, 2023

✔ NPI 1104104413 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyRegistered NurseNursing Service Providers

Taxonomy Code163W00000X

License✔ Licensed in MS · 163W00000X

Definition

(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.

Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X · License 904842 (MS)

3444 WISCONSIN AVE, Vicksburg, MS 39180

Open in Google Maps ↗

Other Names 1

Professional Name (2)Mrs. Latasha Jackson Claiborrne Np

Secondary Practice Locations 2

Location 11905 Mission 66Vicksburg, MS 39180-3711 · Phone (601) 738-5820

Location 21701 White StMcComb, MS 39648 · Phone (601) 249-4214 · Fax (601) 249-1062

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Latasha Jackson Claiborne Pmhnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7214317296

PECOS Enrollment IDI20220707004064

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Latasha Claiborne reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Warren Yazoo Mental Health Service

0.1 mi

Mental Health (Including Community Mental Health Center)

3444 WISCONSIN AVE
Vicksburg, MS 39180

Reassigned Medicare billing, Mississippi enrollment
12 clinicians in this Medicare group

NPI 1023002920 (601) 638-0031

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

37 services18 patients

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TIFFANY SMITH

Counselor (Mental Health)