Individual provider Active NPI

Leslie Rollins, FNP

  • Family Nurse Practitioner
  • Sumrall, MS
National Provider Identifier
1417466079
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
902089 Issued in MS
Practice address
4881 Highway 589
Sumrall, MS 39482-4453
Phone
(601) 336-9099
Fax
(601) 550-6184
NPI assigned
Sep 27, 2017
Last updated
Jul 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 902089 MS
Family Nurse Practitioner 363LF0000X 902089 MS Primary

Addresses

Primary practice location

4881 Highway 589
Sumrall, MS 39482-4453

Mailing address

P.O Box Hwy 589 Sumrall
Sumrall, MS 39482
Phone (013) 366-9099

Other identifiers 1

IdentifierTypeStateIssuer
07228379MedicaidMS

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
I20171110002942 MS Practitioner - Nurse Practitioner 1052677879 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
902089MSMDCritical Care Medicine Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic PA CurrentSince Oct 23, 2017 Accepting new patients
Kids Bright Clinic LLC Nurse Practitioner CurrentSince Aug 17, 2025 Accepting new patients
Hattiesburg Clinic, PA CurrentSince Oct 23, 2017 Accepting new patients

Locations

101 Medical Park
Hattiesburg, MS 39401
Phone (601) 268-3735

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

Interoperability endpoints

  • Direct secure messaging: ltodd66242@directpatientrecord.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": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1417466079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O BOX HWY 589 SUMRALL",
            "city": "SUMRALL",
            "state": "MS",
            "postal_code": "39482",
            "telephone_number": "013-366-9099",
            "fax_number": "601-550-6184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 HIGHWAY 589",
            "city": "SUMRALL",
            "state": "MS",
            "postal_code": "394824453",
            "telephone_number": "601-336-9099",
            "fax_number": "601-550-6184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLLINS",
        "first_name": "LESLIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "902089",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07228379",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumrall, MS

Sources for this page

Verify at the official NPI Registry.