NPIMap

Individual provider Active NPI

Jennifer B Warren, FNP-C

  • Family Nurse Practitioner
  • Southaven, MS
National Provider Identifier
1174872626
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R879367 Issued in MS
Practice address
3495 Cobblestone Blvd S
Southaven, MS 38672-7075
Phone
(662) 892-2885
Fax
(662) 890-1551
NPI assigned
Aug 30, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R879367 MS
Family Nurse Practitioner 363LF0000X R879367 MS Primary

Addresses

Primary practice location

3495 Cobblestone Blvd S
Southaven, MS 38672-7075

Mailing address

3495 Cobblestone Blvd S
Southaven, MS 38672-7075
Phone (662) 892-2885

Other identifiers 1

IdentifierTypeStateIssuer
01028095MedicaidMS

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
I20120925000526 MS Practitioner - Nurse Practitioner 9133378748 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Medical Clinic of North Ms IncGroup PAC ID 5294790861, 13 clinicians

Practice addresses (Care Compare)

3451 Goodman Rd E
Suite 115
Southaven, MS 38672-9304
Phone (662) 890-5555

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R879367MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midsouth Medicine CurrentSince Sep 17, 2012 Accepting new patients
Desoto Family Wellness Center, LLC Family Medicine CurrentSince Feb 1, 2021 Accepting new patients
Stonebridge Medical Group, PLC PastSince Sep 17, 2012 Accepting new patients

Locations

2149 Stateline Rd W
Southaven, MS 38671
Phone (662) 342-1112

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GCEIBA
  • Direct secure messaging: jwarren@fmconm-ms.direct.office.nextgen.com

Organizations & group practices 4

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 6

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": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647907200000",
    "number": "1174872626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 COBBLESTONE BLVD S",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386727075",
            "telephone_number": "662-892-2885",
            "fax_number": "662-890-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3495 COBBLESTONE BLVD S",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386727075",
            "telephone_number": "662-892-2885",
            "fax_number": "662-890-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "JENNIFER",
        "middle_name": "B",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2022-03-22",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "R879367",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R879367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01028095",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.