Active NPI
Jacenta Matthews, PHARMD
- Pharmacist
- Vicksburg, MS
National Provider Identifier
1245706803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PST.022886
- Practice address
- 1435 N Frontage Rd
Vicksburg, MS 39180-5170 - Phone
- (601) 661-9652
- NPI assigned
- Oct 22, 2018
- Last updated
- Sep 18, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E15632 | MS | |
| Pharmacist | 183500000X | PST.022886 | LA | Primary |
Addresses
Primary practice location
1435 N Frontage Rd
Vicksburg, MS 39180-5170
Mailing address
1842 Tita St
New Orleans, LA 70114-3383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.022886 | LA | MD | Pharmacist |
| E15632 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mississippi CVS Pharmacy LLC | Past | Accepting new patients | |
| Mississippi CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600387200000",
"number": "1245706803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1842 TITA ST",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701143383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1435 N FRONTAGE RD",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391805170",
"telephone_number": "601-661-9652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHEWS",
"first_name": "JACENTA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-22",
"last_updated": "2020-09-18",
"certification_date": "2020-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E15632",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.022886",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.