NPIMap

Organization Active NPI

Jackson Public Schools Northwest Clinic

  • School Registered Nurse
  • Jackson, MS
National Provider Identifier
1609901503
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Registered NurseTaxonomy code 163WS0200X
License
08671872 Issued in MS
Legal business name
JACKSON PUBLIC SCHOOLS NORTHWEST CLINIC
Practice address
7020 Hwy 49 N
Jackson, MS 39213
Phone
(601) 713-1776
Fax
(601) 713-0579
NPI assigned
Feb 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Earl Watkins, PH.D
Title
Superintendent
Phone
(601) 960-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WS0200X 08671872 MS Primary

Addresses

Primary practice location

7020 Hwy 49 N
Jackson, MS 39213

Mailing address

662 S President St
Jackson, MS 39201-5601
Phone (601) 960-8705

Other identifiers 1

IdentifierTypeStateIssuer
08671872MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Jackson Public School District13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609901503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "662 S PRESIDENT ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392015601",
            "telephone_number": "601-960-8705",
            "fax_number": "601-960-8704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7020 HWY 49 N",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39213",
            "telephone_number": "601-713-1776",
            "fax_number": "601-713-0579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PUBLIC SCHOOLS NORTHWEST CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "EARL",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "601-960-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, School",
            "state": "MS",
            "license": "08671872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08671872",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.