NPIMap

Individual provider Active NPI

Jacob Warren Spring, FNP

  • Family Nurse Practitioner
  • Brookhaven, MS
National Provider Identifier
1255946018
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
904385 Issued in MS
Practice address
414 Hardy LN
Brookhaven, MS 39601-4046
Phone
(601) 320-6886
NPI assigned
Sep 9, 2020
Last updated
Feb 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 893703 MS
Family Nurse Practitioner 363LF0000X 904385 MS Primary
Student in an Organized Health Care Education/Training Program 390200000X 893703 MS

Addresses

Primary practice location

414 Hardy LN
Brookhaven, MS 39601-4046

Mailing address

414 Hardy LN
Brookhaven, MS 39601-4046
Phone (601) 320-6886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220124000770 MS Practitioner - Nurse Practitioner 4284026386 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kings Daughters Medical CenterGroup PAC ID 3072575539, 75 clinicians
Covington County HospitalGroup PAC ID 4183517253, 44 clinicians

Practice addresses (Care Compare)

427 Hwy 51 N
Brookhaven, MS 39601-2350
Phone (601) 833-6011

701 S Holly Ave
Collins, MS 39428-3894
Phone (601) 765-6711

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
904385MSMDFamily Nurse Practitioner
893703MSMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Covington County Hospital CurrentSince Mar 1, 2025 Accepting new patients
Kings Daughters Medical Center Current Accepting new patients
Covington County Hospital Current Accepting new patients
Covington County Hospital CurrentSince Mar 1, 2025 Accepting new patients
King's Daughters Medical Center CurrentSince Jan 4, 2022 Accepting new patients
King's Daughters Medical Center CurrentSince Jan 4, 2022 Accepting new patients

Locations

427 Highway 51 N
Brookhaven, MS 39601
Phone (601) 833-6011

3275 Highway 49
Ste E
Collins, MS 39428
Phone (601) 765-6292

701 S Holly Ave
Collins, MS 39428
Phone (601) 765-3180

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/covingc-3983785e

Organizations & group practices 6

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 3

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": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1255946018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 HARDY LN",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396014046",
            "telephone_number": "601-320-6886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 HARDY LN",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396014046",
            "telephone_number": "601-320-6886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPRING",
        "first_name": "JACOB",
        "middle_name": "WARREN",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-09",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "893703",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904385",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MS",
            "license": "893703",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookhaven, MS

Sources for this page

Verify at the official NPI Registry.