Kimberly Pierce Nelson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R865368 Issued in MS

Practice address

969 Lakeland Dr
Jackson, MS 39216-4606

Phone

(601) 200-6836

Fax

(601) 200-0128

NPI assigned

Aug 24, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kimberly Dawn Pierce Former name

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

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Dominic Jackson MemorialGroup PAC ID 4385531847, 56 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• St. Dominic Jackson Memorial

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1235173691

  MS

  Medicare reassignment Care Compare group NPD
• St Dominic Hospital Crna'S

  • Certified Registered Nurse Anesthetist
  • Jackson, MS
  • NPI 1467682195
  NPD

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

• St Dominic-Jackson Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1306876065

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595203200000",
    "number": "1124334511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23457",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253457",
            "telephone_number": "601-200-6836",
            "fax_number": "601-200-0128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164606",
            "telephone_number": "601-200-6836",
            "fax_number": "601-200-0128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KIMBERLY",
        "middle_name": "PIERCE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-24",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R865368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ST DOM",
            "identifier": "468179YKHV",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07175291",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "PIERCE",
            "middle_name": "DAWN",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carolyn Nelson
• Cassandra Shanika Nelson, PERSONAL CARE ASSIST
• Darlene Nelson
• George A Nelson
• Kevin Mann Nelson, DMD
• Morgan Alexis Nelson
• Phil Otis Nelson Jr., M.D.
• Mary S. Nelums, PHD, LCSW
• Laura Nerren, PHARMD
• Whitney Herron Nesbit, OTR/L

• All providers in Jackson, MS
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.