NPIMap

Individual provider Active NPI

Jennifer L Jurich, NP-C

  • Family Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1366774879
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R872972 Issued in MS
Practice address
15476 Dedeaux Rd
Gulfport, MS 39503-2637
Phone
(228) 230-2663
NPI assigned
Feb 8, 2010
Last updated
Apr 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R872972 MS
Family Nurse Practitioner 363LF0000X R872972 MS Primary
Emergency Registered Nurse 163WE0003X R872972 MS

Addresses

Primary practice location

15476 Dedeaux Rd
Gulfport, MS 39503-2637

Mailing address

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

Other practice location 1

1720A Medical Park Dr Ste 220
Biloxi, MS 39532-2127
Phone (228) 230-2663

Other practice location 2

8924 Live Oak Ave
Ocean Springs, MS 39564-8540
Phone (228) 669-8552

Other names 1

  • Jennifer L Henderson Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100622000331 MS Practitioner - Nurse Practitioner 5597896456 Reassigns benefits to 6 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
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

15476 Dedeaux Rd
Suite B
Gulfport, MS 39503-2637
Phone (228) 230-2663

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-4499

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R872972MSMDEmergency Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Health System CurrentSince Apr 1, 2019 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Cooper Family Medical Center Inc. CurrentSince Aug 11, 2020 Accepting new patients
Bienville Orthopaedic Specialists, LLC CurrentSince Feb 15, 2021 Accepting new patients
Bienville Orthopaedic Specialists, LLC CurrentSince Feb 15, 2021 Accepting new patients
App of Mississippi Ed, LLC CurrentSince Mar 16, 2018 Accepting new patients
Singing River Gulfport CurrentSince Nov 1, 2022 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Jul 8, 2022 Accepting new patients
Stone County Hospital, Inc Past Accepting new patients

Locations

150 Reynoir St
Biloxi, MS 39530
Phone (228) 284-2389

1720A Medical Park Dr
Ste 220
Biloxi, MS 39532
Phone (228) 392-9355

921 Cedar Lake Rd
Ste E
Biloxi, MS 39532
Phone (228) 396-3945

1104 Broad Ave
#B
Gulfport, MS 39501
Phone (228) 314-1340

15476 Dedeaux Rd
Gulfport, MS 39503
Phone (228) 539-3232

15476 Dedeaux Rd
#B
Gulfport, MS 39503
Phone (228) 679-3001

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

1850 Chadwick Dr
Jackson, MS 39204
Phone (601) 376-1000

3099 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 872-2403

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

2819 Denny Ave
Pascagoula, MS 39581
Phone (228) 762-3466

6300 E Lake Blvd
Ste 301
Vancleave, MS 39565

1434 Central Ave E
Wiggins, MS 39577
Phone (601) 928-6600

Interoperability endpoints

  • Direct secure messaging: jjurich@bienvilleortho.gwaydirect.com

Organizations & group practices 11

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 63

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1366774879",
    "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": "15476 DEDEAUX RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395032637",
            "telephone_number": "228-230-2663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1720A Medical Park Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Biloxi",
            "state": "MS",
            "postal_code": "395322127",
            "country_code": "US",
            "telephone_number": "228-230-2663",
            "fax_number": "228-546-3257",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8924 Live Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Ocean Springs",
            "state": "MS",
            "postal_code": "395648540",
            "country_code": "US",
            "telephone_number": "228-669-8552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JURICH",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-08",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R872972",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R872972",
            "primary": true
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "MS",
            "license": "R872972",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "HENDERSON",
            "middle_name": "L",
            "credential": "NP-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.