Kellie J Watkins, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

902465 Issued in MS

Practice address

129 Fountains Blvd
Madison, MS 39110

Phone

(769) 300-0730

NPI assigned

Jan 5, 2018

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

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Trustcare Health, LLCGroup PAC ID 0547427858, 40 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

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19538/brand/2/csg/1/fhir/r4
• Direct secure messaging: kellie.watkins.1@19538.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/19538/brand/1/csg/1/fhir/r4

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.

• Trustcare Health, LLC

  • Family Medicine Physician
  • Ridgeland, MS
  • NPI 1427338235
  Medicare reassignment Care Compare group NPD
• Comprehensive Pain Center of Mississippi

  • Interventional Pain Medicine Physician
  • Madison, MS
  • NPI 1124275565
  Medicare reassignment NPD
• Gluckstadt TC Kids, LLC

  • Pediatrics Physician
  • Madison, MS
  • NPI 1255947297
  Medicare reassignment NPD
• Mississippi Sports Medicine & Orthopaedic Center

  • Orthopaedic Surgery Physician
  • Jackson, MS
  • NPI 1568415560
  Medicare reassignment NPD
• St. Dominic Jackson Memorial

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1235173691
  NPD (past)
• Trustcare Primary Care, LLC

  • Family Medicine Physician
  • Madison, MS
  • NPI 1174078554
  NPD (past)
• Advantage Health Saint Mary'S Medical Group

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1952340911
  NPD (past)

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
  Care Compare affiliation

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

{
    "created_epoch": "1515110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1194232660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 FOUNTAINS BLVD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106318",
            "telephone_number": "769-300-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 FOUNTAINS BLVD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39110",
            "telephone_number": "769-300-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATKINS",
        "first_name": "KELLIE",
        "middle_name": "J",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-05",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Warman, RPH
• Cathrine Warren
• Kathy Ward Warwick, RD/CDE
• Tina Washington-Anderson, LPC
• Nina T Washington, MD
• Sarah Watkins
• Craig A Watson, LPC
• Gayle Watters, DMD
• Waymaker Enterprises, LLC
• John C Webb, L.P.C.

• Family Nurse Practitioner in Madison, MS
• Providers in Madison, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.