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

529 Lake St Ste B
Hazlehurst, MS 39083-2226

Phone

(601) 668-8400

Fax

(601) 623-9246

NPI assigned

Feb 26, 2016

Last updated

Sep 18, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tiffany Rochelle Jackson, FNPNPI 1124410022

Title

Family Nurse Practitioner

Phone

(601) 668-8400

Specialties & licenses 2

Addresses

Other names 1

• Kids First Pediatric Clinic, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

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
  • Pearl, MS
  • NPI 1285305060
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Kids First Pediatric & Adult Medicine, LLC

  • Family Health Clinical Nurse Specialist
  • Pearl, MS
  • NPI 1285305060
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tiffany Jackson, FNP-C

  • Nurse Practitioner
  • Pearl, MS
  • NPI 1124410022
  Medicare reassignment NPD Authorized official
• Brittney Marie Peyton, FNP-BC

  • Family Nurse Practitioner
  • Monticello, MS
  • NPI 1295512457
  NPD

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

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631923200000",
    "number": "1356701783",
    "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": "601-668-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 LAKE ST STE B",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "390832226",
            "telephone_number": "601-668-8400",
            "fax_number": "601-623-9246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS FIRST PEDIATRIC & ADULT MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-26",
        "last_updated": "2021-09-18",
        "certification_date": "2021-09-03",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "ROCHELLE",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "601-668-8400",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "364SP0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Pediatrics",
            "state": "MS",
            "license": "R881238",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids First Pediatric Clinic, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Family Health Clinical Nurse Specialist in Hazlehurst, MS
• Providers in Hazlehurst, 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 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.