Jacqueline Neal
Individual provider Active NPI Family Nurse Practitioner · MC Henry, MS
NPI 1669068136 · NPPES record last updated Dec 17, 2020
Key facts
- NPI
- 1669068136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 904114 (MS)
- Practice address
- 61 Jim Bowden Rd
MC Henry, MS 39561-6092 - Phone
- (228) 697-3796
- NPI assigned
- Dec 17, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 60
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Exceed Physical Therapy, LLC
Memorial Hospital at Gulfport
Practice addresses (Care Compare)
12261 Hwy 49
Suite 1
Gulfport, MS 39503-2976
Phone (228) 265-7185
4215 15TH St
Gulfport, MS 39501-2523
Phone (228) 863-5211
Hospital & facility affiliations
- Memorial Hospital at Gulfport
- Memorial Hospital Biloxi
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210428001090 | MS | Practitioner - Nurse Practitioner | 7618385873 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Current |
Accepting new patients | |
| Memorial Hospital at Gulfport | Past | Accepting new patients |
Locations
1340 Broad Ave
Ste 410
Gulfport, MS 39501
Phone (228) 575-1775
1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856
4215 15th St
Gulfport, MS 39501
Phone (228) 863-5211
4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872
Interoperability endpoints
- jneal@direct.mhg.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 904114 | MS | Yes |
Addresses
Primary practice location
61 Jim Bowden Rd
MC Henry, MS 39561-6092
Mailing address
61 Jim Bowden Rd
MC Henry, MS 39561-6092
Phone (228) 697-3796
Other providers in MC Henry, MS
All providers in MC Henry, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.