Individual provider Active NPI

Sherquita Johnson-Banks, CFNP

  • Family Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1366991101
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
901775 Issued in MS
Practice address
3502 W Northside Dr
Jackson, MS 39213-4454
Phone
(601) 362-5321
Fax
(601) 364-5124
NPI assigned
Sep 21, 2016
Last updated
Aug 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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 901775 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

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
I20171026002458 MS Practitioner - Nurse Practitioner 8628344231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

129 White Oak St
Utica, MS 39175-8803
Phone (601) 885-6021

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
901775MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Mississippi Civic Improvement Association, Inc CurrentSince Aug 28, 2018 Accepting new patients
Central Mississippi Civic Improvement Association, Inc. CurrentSince Aug 28, 2018 Accepting new patients
Central Mississippi Civic Improvement Association, Inc. Past Accepting new patients

Locations

3502 W Northside Dr
Jackson, MS 39213
Phone (601) 982-1625

129 White Oak St
Utica, MS 39175
Phone (601) 885-6021

Interoperability endpoints

  • Direct secure messaging: sherquita.johnson@jhchc.eclinicaldirectplus.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1366991101",
    "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",
            "fax_number": "601-364-5124"
        },
        {
            "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",
            "fax_number": "601-364-5124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON-BANKS",
        "first_name": "SHERQUITA",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-21",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "901775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.