Kimyuana Jackson Dorris, PMHNP, AGNP-C

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

904207 Issued in MS

Practice address

215 Katherine Dr Ste a
Flowood, MS 39232-9588

Phone

(601) 665-4162

Fax

(888) 398-1151

NPI assigned

Oct 11, 2020

Last updated

Aug 6, 2026By the provider in NPPES

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 names 1

• Kimyuana Dorris Other name

Medicare fee-for-service enrollment

Enrolled in MS, AL, GA3 enrollments

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 3

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maxie Gordon MD and Associates, PLLCGroup PAC ID 1658442843, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

• Maxie Gordon MD & Associates, PLLC

  dba Gordon Medical Arts Clinic

  • Psychiatry Physician
  • Clinton, MS
  • NPI 1114105665
  Medicare reassignment Care Compare group
• NP Care Anywhere LLC

  • Adult Medicine Physician
  • Clinton, MS
  • NPI 1609718915
  Medicare reassignment NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880

  Adult Medicine

  NPD (past)

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

{
    "created_epoch": "1602374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1184222374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 HOBO FORK RD",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391209025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 KATHERINE DR STE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329588",
            "telephone_number": "601-665-4162",
            "fax_number": "888-398-1151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "590 Springridge Rd",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "MS",
            "postal_code": "390565606",
            "country_code": "US",
            "telephone_number": "190-456-3568",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 Hobo Fork Rd",
            "address_purpose": "LOCATION",
            "city": "Natchez",
            "state": "MS",
            "postal_code": "391209025",
            "country_code": "US",
            "telephone_number": "601-304-2558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON DORRIS",
        "first_name": "KIMYUANA",
        "credential": "PMHNP, AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-11",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MS",
            "license": "904207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMYUANA",
            "last_name": "DORRIS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Internal Medicine Primary Care PA
• Internal Medicine Specialists PLLC
• J & R, Inc. Dba Rhonda Roush LPC (Rhonda Roush LPC)
• Jackson Arthritis Clinic PA
• Jackson Dental Care, PLLC
• Jackson Ear Clinic PA
• Jackson Emergency Associates LLC
• Jackson Healthcare for Women PA
• Jackson Heart and Vascular Center LLC
• Jackson Imaging

• Adult Medicine Physician in Flowood, MS
• Providers in Flowood, MS by specialty
• Adult Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; 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.