Active NPI
Maybelle F. Jackson, NP
- Family Nurse Practitioner
- Jackson, MS
National Provider Identifier
1639279920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R672947
- Practice address
- 1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116 - Phone
- (601) 362-4471
- NPI assigned
- Sep 25, 2006
- 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 | R672947 | MS | Primary |
Addresses
Primary practice location
1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116
Mailing address
45 Saragossa Rd
Natchez, MS 39120-8663
Phone (601) 445-9942
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140320001290 | MS | Order and Referring Only - Nurse Practitioner | 9739310574 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639279920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 SARAGOSSA RD",
"city": "NATCHEZ",
"state": "MS",
"postal_code": "391208663",
"telephone_number": "601-445-9942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 E WOODROW WILSON AVE",
"city": "JACKSON",
"state": "MS",
"postal_code": "392165116",
"telephone_number": "601-362-4471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MAYBELLE",
"middle_name": "F.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MS",
"license": "R672947",
"primary": true
}
],
"identifiers": [],
"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 Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.