Kids First Pediatric & Adult Medicine, LLC

Primary specialty

Family Health Clinical Nurse SpecialistTaxonomy code 364SF0001X

Legal business name

KIDS FIRST PEDIATRIC & ADULT MEDICINE, LLC

Practice address

404 Riverwind Dr Ste B-1
Pearl, MS 39208-5900

Phone

(601) 623-9245

Fax

(601) 623-9246

NPI assigned

Sep 22, 2021

Organization subpart

Yes

Parent organization

KIDS FIRST PEDIATRIC & ADULT MEDICINE, LLCAs reported in NPPES

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

Authorized official

Name

Tiffany Jackson, FNPNPI 1124410022

Title

Family Nurse Practitioner

Phone

(601) 623-9245

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Kids First Pediatric Adult Medicine LLC2 organizations share this tax ID, including this one

Part of

Kids First Pediatric Adult Medicine LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Kids First Pediatric & Adult Medicine, LLC

  • Family Health Clinical Nurse Specialist
  • Hazlehurst, MS
  • NPI 1356701783
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Kids First Pediatric & Adult Medicine, LLC

  • Family Health Clinical Nurse Specialist
  • Hazlehurst, MS
  • NPI 1356701783
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tiffany Jackson, FNP-C

  • Nurse Practitioner
  • Pearl, MS
  • NPI 1124410022
  NPD Authorized official

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

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632268800000",
    "number": "1285305060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 495",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392050495",
            "telephone_number": "601-623-9245",
            "fax_number": "601-623-9246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 RIVERWIND DR STE B-1",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392085900",
            "telephone_number": "601-623-9245",
            "fax_number": "601-623-9246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS FIRST PEDIATRIC & ADULT MEDICINE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDS FIRST PEDIATRIC & ADULT MEDICINE, LLC",
        "enumeration_date": "2021-09-22",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-03",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "601-623-9245",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kurt Darwin Johnson, MD
• Teleshia Danielle Johnson, DMD
• Joseph Joseph Joseph, O.D.
• Shireisla Denae Kelly, NP
• Key Dental Group of Pearl LLC
• Olivia Kincaid
• Catrina D Kitchens
• William Frederick Krooss, MD
• Mitchell Ray Langston, R.PH.
• Lifesteps, Inc

• Family Health Clinical Nurse Specialist in Pearl, MS
• Providers in Pearl, MS by specialty
• Family Health Clinical Nurse Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.