Individual provider Active NPI

Donna Recal Watson, FNP

  • Family Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1285866640
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R830232 Issued in MS
Practice address
3502 W Northside Dr
Jackson, MS 39213-4454
Phone
(601) 362-5321
NPI assigned
Aug 19, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R830232 MS Primary

Addresses

Primary practice location

3502 W Northside Dr
Jackson, MS 39213-4454

Mailing address

3502 W Northside Dr
Jackson, MS 39213-4454
Phone (601) 362-5321

Other practice location 1

911 Ellis Ave
Jackson, MS 39209-6256
Phone (601) 533-7016

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
I20100702000434 MS Practitioner - Nurse Practitioner 5092846295 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Street Health Physicians Group of Mississippi, LLCGroup PAC ID 7012334170, 16 clinicians

Practice addresses (Care Compare)

911 Ellis Ave
Jackson, MS 39209-6256
Phone (601) 533-7016

Hospital & facility affiliations

  • Sta Home Health Agency of Jackson, Inc. Dba Accentcare Home Health of Jackson Home health agency, Clinton, MS, CCN 257102

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R830232MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Mississippi, PLLC Family CurrentSince Jun 1, 2021 Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince Jun 1, 2021 Accepting new patients
Community Care Health Network LLC CurrentSince May 1, 2024 Accepting new patients
McFatter Family Medical, LLC PastSince Aug 30, 2021 Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

232 Market St
Jackson, MS 39232
Phone (588) 498-6767

517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206

Organizations & group practices 5

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.

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": "1250640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1285866640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3502 W NORTHSIDE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134454",
            "telephone_number": "601-362-5321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 W NORTHSIDE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134454",
            "telephone_number": "601-362-5321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 Ellis Ave",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392096256",
            "country_code": "US",
            "telephone_number": "601-533-7016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "DONNA",
        "middle_name": "RECAL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-19",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R830232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.