Dominique Alexis Jackson, PMHNP-C

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

906979 Issued in MS

Practice address

604 Highway 80 W Ste P-1
Clinton, MS 39056-4108

Phone

(601) 589-4854

Fax

(601) 893-7096

NPI assigned

Aug 22, 2024

Last updated

Sep 24, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Yeates Consulting LLCGroup PAC ID 3678815396, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jackson Mental Health Services, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Hermanville, MS
  • NPI 1144196940
  Medicare reassignment NPD Authorized official
• Yeates Consulting ,LLC

  • Community/Behavioral Health Agency
  • Columbus, MS
  • NPI 1104235951
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1724284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790208000000",
    "number": "1487487864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 HIGHWAY 80 W STE P-1",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390564108",
            "telephone_number": "601-589-4854",
            "fax_number": "601-893-7096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 HIGHWAY 80 W STE P-1",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390564108",
            "telephone_number": "601-589-4854",
            "fax_number": "601-893-7096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DOMINIQUE",
        "middle_name": "ALEXIS",
        "credential": "PMHNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-22",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "906979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• III Gen
• Ija Development Firm LLC
• August Irving
• J&D Transit Registered LLC of Ms (J&D Transit)
• Patricia Noel Jackson-Wolfe, DPC
• Rena Rosett Jackson, RN
• Hakim A Jamison
• Jea Optical LLC
• Jordan Jenkins
• John D Wise III (Comfortwise Footwear)

• Psychiatric/Mental Health Nurse Practitioner in Clinton, MS
• Providers in Clinton, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.