DR. OTRIE BERTRELLE HICKERSON


Address: 1134 Winter St, Jackson, MS 39204-2841
Phone: 6019485572

DR. OTRIE BERTRELLE HICKERSON (NPI# 1578739934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1578739934
Entity Type Individual
Full Name DR. OTRIE BERTRELLE HICKERSON
Other Name DR. OTRIE B HICKERSON-SMITH
Credential M. D.
Practice Address 1134 Winter St
Jackson
MS 39204-2841
Practice Telephone 6019485572
Practice Fax Number 6013537070
Mailing Telephone 6019485572
Mailing Fax Number 6013537070
Enumeration Date 2008-05-06
Last Update Date 2008-05-06
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 172V00000X Community Health Worker 05738 MS Other Service Providers

Office Location

Street Address 1134 WINTER ST
City JACKSON
State MS
Zip Code 39204-2841

Providers in the same location

NPI Name Taxonomy Address Enumeration
1144281262 Michael Reese Johnson Family Medicine 1134 Winter St, Jackson, MS 39204-2841 2006-03-29
1215560545 Chinnika Latrice Crisler Social Worker 1134 Winter St, Jackson, MS 39204-2841 2020-02-14
1912471939 Zipora Martin-brown Nurse Practitioner 1134 Winter St, Jackson, MS 39204-2841 2019-01-12
1538697453 Trevalla Kaye Lindsey Nurse Practitioner 1134 Winter St, Jackson, MS 39204-2841 2017-05-23
1073069498 Central Mississippi Health Services, Inc. Preferred Provider Organization 1134 Winter St, Jackson, MS 39204-2841 2016-08-26
1982001632 Catina Shavon Butler Nurse Practitioner 1134 Winter St, Jackson, MS 39204-2841 2014-11-24
1376948075 Shaquita Shaw Nurse Practitioner 1134 Winter St, Jackson, MS 39204-2841 2014-10-24
1427458819 Latoya P. Johnson Physician Assistant 1134 Winter St, Jackson, MS 39204-2841 2014-09-04
1568598027 Ericka M Micou Nurse Practitioner 1134 Winter St, Jackson, MS 39204-2841 2007-02-26
1851321384 Obie M. Mcnair Internal Medicine 1134 Winter St, Jackson, MS 39204-2841 2006-07-03
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1639797442 Walk By Faith Not By Sight Homecare Student in an Organized Health Care Education/Training Program 2310 Us-80 West, Suite F 1154, Jackson, MS 39204 2020-07-08
1427593888 Care First Home Care Agency, Inc In Home Supportive Care 931 Hwy 80 Suite 2 B-9, Jackson, MS 39204 2016-12-21
1134678808 Yolonda Kinzie Registered Nurse 1134 Winter St., Jackson, MS 39204 2016-09-23
1578983938 Seaneather Arline Mcgill Nurse's Aide 2024 Shady Lane Dr, Jackson, MS 39204 2014-04-23
1942591128 Real Solutilons, LLC Exclusive Provider Organization 831 Hwy 80 W., Jackson, MS 39204 2011-04-22
1548405236 Visions Physical Therapy Specialist/Technologist 4700 Robinson Rd, Jackson, MS 39204 2008-12-09
1588759393 Donald H Butts Specialist 1920 Chadwick Drive, Suite 109, Jackson, MS 39204 2006-10-04
1003907460 Patrick E Weldon Psychiatry & Neurology 1860 Chadwick Drive, Suite 258, Jackson, MS 39204 2006-09-28
1922117662 Elgin Kenneth Walley Dentist 2174 Henry Hill Drive, Jackson, MS 39204 2006-08-29
1376555045 Linda Nell Hunter Nurse Practitioner 1860 Chadwick Dr Ste 150a, Jackson, MS 39204 2006-08-12
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Taxonomy Information

Taxonomy Code 172V00000X
Grouping Other Service Providers
Classification Community Health Worker

Taxonomy Definition

Community health workers (CHW) are lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status and life experiences with the community members they serve. They have been identified by many titles such as community health advisors, lay health advocates, "promotores(as), outreach educators, community health representatives, peer health promoters, and peer health educators. CHWs offer interpretation and translation services, provide culturally appropriate health education and information, assist people in receiving the care they need, give informal counseling and guidance on health behaviors, advocate for individual and community health needs, and provide some direct services such as first aid and blood pressure screening. Some examples of these practitioners are Community Health Aides or Practitioners established under 25 USC §1616 (l) under HHS, Indian Health Service, Public Health Service.
Notes: Source: Health Resources and Services Administration, US Department of Health and Human Services – National Workforce Study on Community Health Workers, March, 2007. [7/1/2007: new] http://bhpr.hrsa.gov/healthworkforce/chw/

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1679111389 Tawny Renee Williams Community Health Worker 409 Briarwood Dr Ste 302, Jackson, MS 39206-3033 2019-12-12
1811343684 Eugene Morgan Community Health Worker 5773 Old Canton Rd, Jackson, MS 39211-3202 2016-05-10
1588022727 Front Page Fame LLC Community Health Worker 115 Directors Row, Jackson, TN 38305-2316 2016-02-02
1548625106 Beth Wingart Community Health Worker 1703 Chapin St, Jackson, MI 49203-2000 2015-12-28
1205205564 Michelle Perusse Community Health Worker 501 Seymour Ave, Jackson, MI 49202-3564 2015-09-16
1639569742 Thomas White Community Health Worker 2370 N High St, Suite Number 5, Jackson, MO 63755-8365 2015-01-27
1316368343 Mcnair Chronic Disease Consultant Community Health Worker 5120 Galaxie Dr Ste B, Jackson, MS 39206-4308 2013-12-17
1700023983 Carli Lyon Community Health Worker 3021 Rangeview Dr, Jackson, WY 83002-3021 2009-01-09
1225287139 Ralph Wendell Mims Community Health Worker 3708 Kennebrew Road, Jackson, MS 39209 2008-09-16
1790331643 Eps On The Go II Community Health Worker 5773 Old Canton Rd, Jackson, MS 39211-3202 2019-08-16
Find all providers in JACKSON

Competitor

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City JACKSON
Zip Code 39204

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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