Active NPI
Timothy Paul McNeill, RN
- Registered Nurse
- Jackson, MS
National Provider Identifier
1093095812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN1013918
- Practice address
- 350 W Woodrow Wilson Ave
#499A
Jackson, MS 39213-7681 - Phone
- (601) 500-7709
- NPI assigned
- Aug 24, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN1013918 | DC | Primary |
Addresses
Primary practice location
350 W Woodrow Wilson Ave
#499A
Jackson, MS 39213-7681
Mailing address
350 W Woodrow Wilson Ave
#499A
Jackson, MS 39213-7681
Phone (601) 500-7709
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN1013918 | DC | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Mall Health Services of Mississippi, LLC | Current | Accepting new patients | |
| Medical Mall Services of Maryland, LLC | Current | Accepting new patients |
Organizations & group practices 2
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.
-
- Primary Care Nurse Practitioner
- Jackson, MS
- NPI 1194083139
-
dba Medical Mall Health Services
- Health Service Clinic/Center
- Cheverly, MD
- NPI 1124398086
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314144000000",
"number": "1093095812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 W WOODROW WILSON AVE",
"address_2": "#499A",
"city": "JACKSON",
"state": "MS",
"postal_code": "392137681",
"telephone_number": "601-500-7709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 W WOODROW WILSON AVE",
"address_2": "#499A",
"city": "JACKSON",
"state": "MS",
"postal_code": "392137681",
"telephone_number": "601-500-7709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCNEILL",
"first_name": "TIMOTHY",
"middle_name": "PAUL",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-24",
"last_updated": "2011-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "DC",
"license": "RN1013918",
"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 Aug 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.