NPIMap

Individual provider Active NPI

Juliet W Richards

  • Family Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1053554808
Registry record updated Oct 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A810304 Issued in MS
Practice address
15444 Dedeaux Rd Ste B
Gulfport, MS 39503-2637
Phone
(228) 832-9038
Fax
(228) 832-9990
NPI assigned
Apr 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A810304 MS Primary

Addresses

Primary practice location

15444 Dedeaux Rd Ste B
Gulfport, MS 39503-2637

Mailing address

15444 Dedeaux Rd Ste B
Gulfport, MS 39503-2637
Phone (228) 832-9038

Other identifiers 3

IdentifierTypeStateIssuer
01859794MedicaidMS
432372YXF9OtherMSMEDICARE PTAN
R882326OtherMSSTATE LICENSE

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
I20100729000679 MS Practitioner - Nurse Practitioner 2466585310 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wound Management Specialists LLCGroup PAC ID 5193056364, 157 clinicians
Healthcare Plus Limited Liability CompanyGroup PAC ID 5698038610, 120 clinicians

Practice addresses (Care Compare)

1190 N State St
Jackson, MS 39202-2413
Phone (769) 243-6141

2781 C T Switzer Sr Dr
Suite 100
Biloxi, MS 39531-4535
Phone (769) 243-6141

Hospital & facility affiliations

  • Deaconess Homecare- Region I Home health agency, Laurel, MS, CCN 257085
  • Panola Medical Center Hospital, Batesville, MS, CCN 250781
  • Memorial Hospital at Gulfport Hospital, Gulfport, MS, CCN 250019
  • Singing River Health System Hospital, Pascagoula, MS, CCN 250040
  • Singing River Gulfport Hospital, Gulfport, MS, CCN 250123

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A810304MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Gulfport CurrentSince Feb 7, 2022 Accepting new patients
Healthcare Plus Limited Liability Company CurrentSince Jul 18, 2023 Accepting new patients
Primary Care Medical Center of Gulfport, PLLC CurrentSince Sep 15, 2019 Accepting new patients
Wound Management Specialists, LLC CurrentSince Jul 31, 2023 Accepting new patients
Vitality Wellness Clinic LLC Past Accepting new patients
Winston Medical Clinic LLC Past Accepting new patients

Locations

2781 C T Switzer SR Dr
Ste 100
Biloxi, MS 39531
Phone (228) 207-8632

778 Liberty Rd
Flowood, MS 39232
Phone (601) 914-9620

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

15444 Dedeaux Rd
#B
Gulfport, MS 39503
Phone (228) 832-9038

14055 Seaway Rd
#200
Gulfport, MS 39503
Phone (228) 832-9038

1190 N State St
Ste 2A
Jackson, MS 39202
Phone (601) 292-4292

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

Organizations & group practices 6

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 65

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

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1239235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1053554808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15444 DEDEAUX RD STE B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395032637",
            "telephone_number": "228-832-9038",
            "fax_number": "228-832-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15444 DEDEAUX RD STE B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395032637",
            "telephone_number": "228-832-9038",
            "fax_number": "228-832-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDS",
        "first_name": "JULIET",
        "middle_name": "W",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-09",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "A810304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01859794",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "432372YXF9",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "R882326",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.