Individual provider Active NPI

Gwendolyn D Harris-Cocroft, FNP

  • Family Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1659660512
Registry record updated Feb 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R859966 Issued in MS
Practice address
605 Stadium Dr
Hattiesburg, MS 39401-4156
Phone
(601) 450-0310
Fax
(601) 450-0321
NPI assigned
Mar 31, 2011
Sex
Female
Sole proprietor
No

Organizations & group practices 7

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.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maxem Health Urgent Care Magee 16 clinicians
Picayune Urgent Care Clinic, LLC 10 clinicians

Practice addresses (Care Compare)

1529 Simpson Hwy 49
Magee, MS 39111-4209
Phone (601) 439-7288

422 Memorial Blvd
Picayune, MS 39466-5544
Phone (601) 798-2151

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
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20130123000339 MS Practitioner - Nurse Practitioner 5395998421 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Mississippi, PLLC Family CurrentSince Oct 15, 2018 Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince Oct 15, 2018 Accepting new patients
Truhealth, LLC CurrentSince Aug 7, 2023 Accepting new patients
The University of Southern Mississippi Past Accepting new patients

Locations

1506 N Main St
Columbia, MS 39429
Phone (601) 735-9557

517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206

925 Calhoun Ave
Yazoo City, MS 39194
Phone (662) 746-6651

1971 Tennessee Ave N
Parsons, TN 38363
Phone (731) 614-1424

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R859966 MS Primary

Addresses

NPPES NPI Registry

Primary practice location

605 Stadium Dr
Hattiesburg, MS 39401-4156

Mailing address

PO Box 1729
Hattiesburg, MS 39403-1729
Phone (601) 545-3700

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
07474202MedicaidMS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 4, 2013.

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359936000000",
    "number": "1659660512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-3700",
            "fax_number": "601-450-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 STADIUM DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394014156",
            "telephone_number": "601-450-0310",
            "fax_number": "601-450-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS-COCROFT",
        "first_name": "GWENDOLYN",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-31",
        "last_updated": "2013-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R859966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07474202",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.