Active NPI
Kellen Dawson
- Dermatopathology (Pathology) Physician
- Jackson, MS
National Provider Identifier
1033615919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatopathology (Pathology) Physician
- License
- 31541
- Practice address
- 3120 Old Canton Rd
Jackson, MS 39216-4219 - Phone
- (800) 685-3772
- NPI assigned
- Apr 1, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatopathology (Pathology) Physician | 207ZD0900X | 31541 | MS | Primary |
Addresses
Primary practice location
3120 Old Canton Rd
Jackson, MS 39216-4219
Mailing address
3120 Old Canton Rd
Jackson, MS 39216-4219
Phone (337) 654-1478
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180731000754 | AR | Order and Referring Only - Pathology | 1153679634 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31541 | MS | MD | Dermatopathology (Pathology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatopathology Associates, PLLC | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Medical Laboratory
- Jackson, MS
- NPI 1356374912
Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759708800000",
"number": "1033615919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3120 OLD CANTON RD",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164219",
"telephone_number": "337-654-1478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3120 OLD CANTON RD",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164219",
"telephone_number": "800-685-3772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAWSON",
"first_name": "KELLEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-01",
"last_updated": "2025-10-06",
"certification_date": "2025-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "207ZD0900X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pathology, Dermatopathology",
"state": "MS",
"license": "31541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.