Active NPI
Jennifer Jackson, NP
- Family Nurse Practitioner
- Gulfport, MS
National Provider Identifier
1518273499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R859293
- Practice address
- 1110 Broad Ave
Ste 700
Gulfport, MS 39501-8907 - Phone
- (228) 867-4580
- Fax
- (228) 867-4708
- NPI assigned
- Aug 30, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R859293 | MS | Primary |
Addresses
Primary practice location
1110 Broad Ave
Ste 700
Gulfport, MS 39501-8907
Mailing address
PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 867-4580
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1110 Broad Ave
Suite 700
Gulfport, MS 39501-8908
Phone (228) 864-0314
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital at Gulfport | Current | Accepting new patients |
Locations
1756 Popps Ferry Rd
Ste A
Biloxi, MS 39532
Phone (228) 865-3200
4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872
Organizations & group practices 2
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.
-
- Urology Physician
- Gulfport, MS
- NPI 1093142598
-
- General Acute Care Hospital
- Biloxi, MS
- NPI 1215546635
Hospital & facility affiliations 60
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Gulfport, MS
- NPI 1073606901
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Gulfport, MS
- NPI 1184956815
Hospital
-
- General Acute Care Hospital
- Biloxi, MS
- NPI 1215546635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404950400000",
"number": "1518273499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1810",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395021810",
"telephone_number": "228-867-4580",
"fax_number": "228-867-4708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 BROAD AVE",
"address_2": "STE 700",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395018907",
"telephone_number": "228-867-4580",
"fax_number": "228-867-4708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JENNIFER",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-30",
"last_updated": "2014-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MS",
"license": "R859293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; 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.