Individual provider Active NPI

Jessica Dale Gossom, APRN

  • Family Nurse Practitioner
  • Paducah, KY
National Provider Identifier
1316507981
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3012939 Issued in KY
Practice address
225 Medical Center Dr Ste 308
Paducah, KY 42003-7915
Phone
(270) 443-0777
NPI assigned
Jun 17, 2019
Last updated
Jun 17, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

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 3012939 KY Primary

Addresses

Primary practice location

225 Medical Center Dr Ste 308
Paducah, KY 42003-7915

Mailing address

225 Medical Center Dr Ste 308
Paducah, KY 42003-7915
Phone (270) 443-0777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20190809002881 KY Practitioner - Nurse Practitioner 5193052371 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Physicians Kentucky Specialty Care LLCGroup PAC ID 1456777069, 144 clinicians

Practice addresses (Care Compare)

225 Medical Ctr Dr
Suite 308
Paducah, KY 42003-7915
Phone (270) 443-0777

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3012939KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Kentucky Specialty Care LLC CurrentSince Sep 1, 2020 Accepting new patients
Mercy Health Physicians Kentucky Specialty Care LLC CurrentSince Sep 1, 2020 Accepting new patients

Locations

1530 Lone Oak Rd
Paducah, KY 42003
Phone (270) 444-2444

1532 Lone Oak Rd
Ste 245
Paducah, KY 42003
Phone (270) 538-5537

1532 Lone Oak Rd
Ste 320
Paducah, KY 42003
Phone (270) 415-3830

225 Medical Center Dr
Ste 308
Paducah, KY 42003
Phone (270) 441-4750

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.

Hospital & facility affiliations 2

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": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1316507981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MEDICAL CENTER DR STE 308",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037915",
            "telephone_number": "270-443-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MEDICAL CENTER DR STE 308",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037915",
            "telephone_number": "270-443-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSSOM",
        "first_name": "JESSICA",
        "middle_name": "DALE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3012939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

Verify at the official NPI Registry.