Avery Jackson, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

902036 Issued in MS

Practice address

14231 Seaway Rd Ste 2003
Gulfport, MS 39503-4635

Phone

(228) 594-3377

Fax

(228) 594-6688

NPI assigned

May 25, 2017

Sex

Male

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

University of South Alabama College of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, 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.

• Gulf Coast Recovery Clinic

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Gulfport, MS
  • NPI 1922888148
  Medicare reassignment NPD
• Orange Grove Urgent Care

  • Urgent Care Clinic/Center
  • Gulfport, MS
  • NPI 1831330661
  Medicare reassignment NPD
• Pascagoula Urgent Care

  • Urgent Care Clinic/Center
  • Pascagoula, MS
  • NPI 1235442872
  Medicare reassignment NPD
• Ocean Springs Urgent Care

  • Urgent Care Clinic/Center
  • Ocean Springs, MS
  • NPI 1871808022
  Medicare reassignment
• Picayune Urgent Care Clinic, LLC

  • Urgent Care Clinic/Center
  • Picayune, MS
  • NPI 1780723502
  Medicare reassignment
• Cooper Family Medical Center Inc.

  • Clinic/Center
  • Pascagoula, MS
  • NPI 1356478564
  NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1495670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1548798218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14231 SEAWAY RD STE 2003",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034635",
            "telephone_number": "228-594-3377",
            "fax_number": "228-594-6688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14231 SEAWAY RD STE 2003",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034635",
            "telephone_number": "228-594-3377",
            "fax_number": "228-594-6688"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1990 Popps Ferry Rd",
            "address_purpose": "LOCATION",
            "city": "Biloxi",
            "state": "MS",
            "postal_code": "395322015",
            "country_code": "US",
            "telephone_number": "228-594-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AVERY",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-25",
        "last_updated": "2022-07-21",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roy L Irons, D.D.S.
• J. J. Hill Brace and Limb Co., Inc.
• Mohammad Awad Jaber, M.D.
• Lakeisha J Jackson-Patton, PHARM.D.
• Aaliyah Jackson
• Christopher E Jackson
• Gary Dean Jackson, R.PH.
• Janice L. Jackson
• Jennifer Jackson, NP
• Linda Natasha Rene Jackson, LPC

• Family Nurse Practitioner in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.