Individual provider Active NPI

Jessica Watson Lott, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Laurel, MS
National Provider Identifier
1013567445
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
903432 Issued in MS
Practice address
404 S 13TH Ave
Laurel, MS 39440-4345
Phone
(601) 425-5544
Fax
(601) 425-5525
NPI assigned
Sep 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 903432 MS
Acute Care Nurse Practitioner 363LA2100X 903432 MS Primary

Addresses

Primary practice location

404 S 13TH Ave
Laurel, MS 39440-4345

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 268-5800

Other practice location 1

415 S 28th Ave
Hattiesburg, MS 39401-7246
Phone (601) 268-5800

Other identifiers 1

IdentifierTypeStateIssuer
09482003MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191202000848 MS Practitioner - Nurse Practitioner 3870926066 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Radiology Services PLLCGroup PAC ID 1759364946, 50 clinicians

Practice addresses (Care Compare)

5000 W 4TH St
Hattiesburg, MS 39402-1000
Phone (800) 494-8260

Hospital & facility affiliations

  • Forrest General Hospital Hospital, Hattiesburg, MS, CCN 250078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
903432MSMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital Current Accepting new patients
Forrest County General Hospital CurrentSince Dec 7, 2019 Accepting new patients
Comprehensive Radiology Services, PLLC CurrentSince Oct 18, 2021 Accepting new patients
Forrest County General Hospital CurrentSince Dec 7, 2019 Accepting new patients

Locations

178 Highway 24 E
Centreville, MS 39631
Phone (601) 890-0500

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

5000 W 4th St
Hattiesburg, MS 39402
Phone (601) 264-2121

404 S 13th Ave
Laurel, MS 39440
Phone (601) 425-5544

347 Magnolia Dr
Raleigh, MS 39153
Phone (601) 374-9070

Organizations & group practices 4

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 1

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": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1013567445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-268-5800",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 S 13TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404345",
            "telephone_number": "601-425-5544",
            "fax_number": "601-425-5525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 S 28th Ave",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394017246",
            "country_code": "US",
            "telephone_number": "601-268-5800",
            "fax_number": "601-261-3530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOTT",
        "first_name": "JESSICA",
        "middle_name": "WATSON",
        "name_prefix": "Mrs.",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "903432",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "903432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09482003",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.