Individual provider Active NPI

Jacob Daniel Kay, MSN, RN, APRN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1073262911
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
905362 Issued in MS
Practice address
2255 Broadway Dr
Hattiesburg, MS 39402-3254
Phone
(601) 288-4800
Fax
(601) 288-4960
NPI assigned
Mar 19, 2022
Last updated
Jul 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 905362 MS Primary
Psychiatric/Mental Health Registered Nurse 163WP0808X 886343 MS

Addresses

Primary practice location

2255 Broadway Dr
Hattiesburg, MS 39402-3254

Mailing address

2255 Broadway Dr
Hattiesburg, MS 39402-3254
Phone (601) 288-8050

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
I20221102001885 MS Practitioner - Nurse Practitioner 9335516434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Forrest County General HospitalGroup PAC ID 1052397767, 107 clinicians

Practice addresses (Care Compare)

1 Lincoln Pkwy
Hattiesburg, MS 39402-3262
Phone (601) 288-8050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
886343MSMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince Jul 16, 2022 Accepting new patients
Forrest County General Hospital Current Accepting new patients
Forrest County General Hospital CurrentSince Jul 16, 2022 Accepting new patients

Locations

1 Lincoln Pkwy
Ste 202
Hattiesburg, MS 39402
Phone (601) 288-8050

2117 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-8050

2255 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-2273

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1647648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1073262911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 BROADWAY DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023254",
            "telephone_number": "601-288-8050",
            "fax_number": "601-288-4960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 BROADWAY DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023254",
            "telephone_number": "601-288-4800",
            "fax_number": "601-288-4960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAY",
        "first_name": "JACOB",
        "middle_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "MSN, RN, APRN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-19",
        "last_updated": "2022-07-25",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "905362",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MS",
            "license": "886343",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.