Jessica Sullivan, CFNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

906933 Issued in MS

Practice address

120 Market St
Woodland, MS 39776-9104

Phone

(662) 456-0111

Fax

(662) 456-7335

NPI assigned

Sep 9, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Woodland Clinic LLC

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Woodland, MS
  • NPI 1629282330
  Medicare reassignment NPD
• Essential Health & Wellness Clinic P.a.

  • Nurse Practitioner
  • Horn Lake, MS
  • NPI 1538786090
  NPD (past)
• Foot Solutions LLC

  • Clinic Pharmacy
  • Woodland, MS
  • NPI 1508072273
  NPD (past)

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

{
    "created_epoch": "1725840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1407682420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18780 HIGHWAY 46",
            "city": "MANTEE",
            "state": "MS",
            "postal_code": "397519514",
            "telephone_number": "662-295-1944",
            "fax_number": "662-456-7335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MARKET ST",
            "city": "WOODLAND",
            "state": "MS",
            "postal_code": "397769104",
            "telephone_number": "662-456-0111",
            "fax_number": "662-456-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JESSICA",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-09",
        "last_updated": "2024-09-09",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "906933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Foot Solutions LLC
• Jerry Sullivan, CFNP
• Woodland Adult Center, LLC
• Woodland Clinic LLC

• Primary Care Nurse Practitioner in Woodland, MS
• Providers in Woodland, MS by specialty
• Primary Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.