Individual provider Active NPI

Thomas Maloney Harkins III, NP

  • Gerontology Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1184574451
Registry record updated Feb 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
908143 Issued in MS
Practice address
971 Lakeland Dr Ste 657
Jackson, MS 39216-4608
Phone
(601) 200-2780
Fax
(601) 200-2788
NPI assigned
Jan 28, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 908143 MS
Gerontology Nurse Practitioner 363LG0600X 908143 MS Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

971 Lakeland Dr Ste 657
Jackson, MS 39216-4608

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (601) 200-2780

Other practice location 1

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

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
I20260301000013 MS Practitioner - Nurse Practitioner 3274015102 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

106 Highland Way
Madison, MS 39110-6933

969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-3100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
908143MSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Dominic Medical Associates LLC CurrentSince Mar 1, 2026 Accepting new patients
St Dominic Medical Associates LLC CurrentSince Mar 1, 2026 Accepting new patients

Locations

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

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

971 Lakeland Dr
Ste 657
Jackson, MS 39216
Phone (601) 200-2780

Organizations & group practices 3

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": "1769558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770768000000",
    "number": "1184574451",
    "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": "601-200-2780",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR STE 657",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164608",
            "telephone_number": "601-200-2780",
            "fax_number": "601-200-2788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "969 Lakeland Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164606",
            "country_code": "US",
            "telephone_number": "601-200-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARKINS",
        "first_name": "THOMAS",
        "middle_name": "MALONEY",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-01-28",
        "last_updated": "2026-02-11",
        "certification_date": "2026-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "908143",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MS",
            "license": "908143",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.