Individual provider Active NPI

Jenna Elizabeth Clark, NP

  • Family Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1104201649
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R890237 Issued in MS
Practice address
971 Lakeland Dr Ste 1250
Jackson, MS 39216-4609
Phone
(601) 200-5955
NPI assigned
Jul 27, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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 R890237 MS Primary

Addresses

Primary practice location

971 Lakeland Dr Ste 1250
Jackson, MS 39216-4609

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (601) 200-4644

Other practice location 1

969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-4644

Other practice location 2

971 Lakeland Dr Ste 356
Jackson, MS 39216-4607
Phone (601) 200-4644

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
I20150928000879 MS Practitioner - Nurse Practitioner 6103134077 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RH Mississippi Hospitalist Medicine LLCGroup PAC ID 0547791873, 74 clinicians
St. Dominic Medical Associates LLCGroup PAC ID 0446303168, 130 clinicians

Practice addresses (Care Compare)

969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-2000

971 Lakeland Dr
Jackson, MS 39216-4643
Phone (601) 200-5955

Hospital & facility affiliations

  • St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as apm
Quality
73.43
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
RH Mississippi Hospitalist Medicine, LLC CurrentSince Aug 14, 2024 Accepting new patients
St Dominic Medical Associates LLC CurrentSince Jun 1, 2025 Accepting new patients
St Dominic Medical Associates LLC Family PastSince Aug 1, 2024 Accepting new patients
St. Dominic Jackson Memorial PastSince Aug 1, 2024 Accepting new patients

Locations

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

971 Lakeland Dr
Ste 1250
Jackson, MS 39216
Phone (601) 200-5955

969 Lakeland Dr
Jackson, MS 39216
Phone (601) 200-4644

Interoperability endpoints

  • Direct secure messaging: jclark2458789@direct.casso.us.com

Organizations & group practices 5

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": "1437955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1104201649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "601-200-4644",
            "fax_number": "225-765-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR STE 1250",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164609",
            "telephone_number": "601-200-5955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "969 Lakeland Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164606",
            "country_code": "US",
            "telephone_number": "601-200-4644",
            "fax_number": "601-200-4645",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "971 Lakeland Dr Ste 356",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164607",
            "country_code": "US",
            "telephone_number": "601-200-4644",
            "fax_number": "601-200-4645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNA",
        "middle_name": "ELIZABETH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-27",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R890237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.