Individual provider Active NPI

Jakob R Benne, PA-C

  • Physician Assistant
  • Biloxi, MS
National Provider Identifier
1336064898
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1720A Medical Park Dr Ste 150
Biloxi, MS 39532-2135
Phone
(228) 230-2663
NPI assigned
Aug 12, 2026
Last updated
Aug 12, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1720A Medical Park Dr Ste 150
Biloxi, MS 39532-2135

Mailing address

6300 E Lake Blvd Ste 301
Vancleave, MS 39565-6771
Phone (228) 230-2663

Other practice location 1

3615 Hospital St
Pascagoula, MS 39581-4112
Phone (228) 230-2663

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)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1786492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1336064898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 E LAKE BLVD STE 301",
            "city": "VANCLEAVE",
            "state": "MS",
            "postal_code": "395656771",
            "telephone_number": "228-230-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720A MEDICAL PARK DR STE 150",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395322135",
            "telephone_number": "228-230-2663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3615 Hospital St",
            "address_purpose": "LOCATION",
            "city": "Pascagoula",
            "state": "MS",
            "postal_code": "395814112",
            "country_code": "US",
            "telephone_number": "228-230-2663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENNE",
        "first_name": "JAKOB",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-08-12",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Biloxi, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.