NPIMap

Individual provider Active NPI

Merrick Greene Jackson, NP

  • Family Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1003420092
Registry record updated Oct 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
904374 Issued in MS
Practice address
3688 Veterans Memorial Dr Ste 200
Hattiesburg, MS 39401-8246
Phone
(601) 554-7400
NPI assigned
Sep 7, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 904374 MS Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

3688 Veterans Memorial Dr Ste 200
Hattiesburg, MS 39401-8246

Mailing address

120 Natalie LN
Hattiesburg, MS 39402-3080
Phone (601) 938-5197

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211011001175 MS Practitioner - Nurse Practitioner 0840698510 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3688 Veterans Memorial Dr
Suite 200
Hattiesburg, MS 39401-8246
Phone (601) 554-7400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
55.35 of 100Reported as individual
Quality
27.13
Promoting interoperability
64
Improvement activities
40
Cost
54.03

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
904374MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Bone & Joint Specialists CurrentSince Mar 1, 2022 Accepting new patients
Southern Bone & Joint Specialists, PA CurrentSince Mar 1, 2022 Accepting new patients
Southern Bone & Joint Specialists, PA PastSince Aug 27, 2023 Accepting new patients

Locations

1215 Highway 98 Byp
Columbia, MS 39429
Phone (601) 268-5070

3688 Veterans Memorial Dr
Ste 200
Hattiesburg, MS 39401
Phone (601) 554-7451

528 N 15th Ave
Ste A
Laurel, MS 39440

1725 Central Ave W
Wiggins, MS 39577
Phone (601) 928-9095

Interoperability endpoints

  • Direct secure messaging: merrick.jackson.p1@direct.southernboneandjoint.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760659200000",
    "number": "1003420092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 NATALIE LN",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023080",
            "telephone_number": "601-938-5197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3688 VETERANS MEMORIAL DR STE 200",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018246",
            "telephone_number": "601-554-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MERRICK",
        "middle_name": "GREENE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-07",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904374",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.