Adria Nicole Adcock, CPNP-AC
Individual provider Active NPI Pediatric Registered Nurse · Jackson, MS
NPI 1447956263 · NPPES record last updated Nov 22, 2024
Key facts
- NPI
- 1447956263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Registered Nurse 163WP0200X
- License
- 905554 (MS)
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-1000
- NPI assigned
- Feb 2, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 24
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- State of Mississippi - University of Mississippi Medical Center
Practice addresses (Care Compare)
2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-4775
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250116004067 | MS | Practitioner - Nurse Practitioner | 9638607708 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 905554 | MS | MD | Pediatric Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Mississippi - University of Mississippi Medical Center | Current | Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients | |
| State of Mississippi-University of Mississippi Medical Center | Current |
Accepting new patients |
Locations
2109 Hardy St
Hattiesburg, MS 39401
Phone (601) 296-3290
2500 N State St
Jackson, MS 39216
Phone (601) 815-4775
2500 N State St
Ste J
Jackson, MS 39216
7730 Old Canton Rd
Madison, MS 39110
Phone (504) 842-3970
Interoperability endpoints
- aryan73366@ummc.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Registered Nurse | 163WP0200X | 905554 | MS | Yes |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
156 Seville Way
Madison, MS 39110-8170
Phone (901) 246-8485
Other practice location 1
156 Seville Way
Madison, MS 39110-8170
Phone (901) 246-8485
Other providers in Jackson, MS
- Rebecca L Adams
- Robert Adams
- Sarah Adams
- Zachary Lee Adams
- Adc Traveling Grace
- Dorothy Adcock
- Kim Griffin Adcock
- Taylor Adcock
- Amy R Adcox
- Charlie Adderley
All providers in Jackson, MS · Pediatric Registered Nurse in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.