Individual provider Active NPI

Jennagrace Earnest

  • Women's Health Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1194142703
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
R879679 Issued in MS
Practice address
1793 Cliff Gookin Blvd
Tupelo, MS 38801-6723
Phone
(662) 842-1161
Fax
(662) 842-6375
NPI assigned
Mar 20, 2014
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X R879679 MS Primary

Addresses

Primary practice location

1793 Cliff Gookin Blvd
Tupelo, MS 38801-6723

Mailing address

1793 Cliff Gookin Blvd
Tupelo, MS 38801-6723
Phone (662) 842-1161

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
I20140610000592 MS Practitioner - Nurse Practitioner 4486878618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Obstetrics Gynecology Associates PAGroup PAC ID 3072500073, 11 clinicians

Practice addresses (Care Compare)

1793 Cliff Gookin Blvd
Tupelo, MS 38801-6723
Phone (662) 842-1161

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center Current Accepting new patients
Obstetrics Gynecology Associates PA CurrentSince Jul 1, 2017 Accepting new patients
Pathgroup Labs, LLC PastSince Jul 1, 2017 Accepting new patients

Locations

1793 Cliff Gookin Blvd
Tupelo, MS 38801
Phone (662) 842-1161

Interoperability endpoints

  • Direct secure messaging: jennagraceearnest@nmhs.medalliesdirect.net

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

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": "1395273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1194142703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1793 CLIFF GOOKIN BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016723",
            "telephone_number": "662-842-1161",
            "fax_number": "662-842-6375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1793 CLIFF GOOKIN BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016723",
            "telephone_number": "662-842-1161",
            "fax_number": "662-842-6375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EARNEST",
        "first_name": "JENNAGRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MS",
            "license": "R879679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.