Robin Jackson
Individual provider Active NPI Acute Care Nurse Practitioner · Tupelo, MS
NPI 1669922670 · NPPES record last updated Oct 13, 2016
Key facts
- NPI
- 1669922670
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acute Care Nurse Practitioner 363LA2100X
- License
- 901796 (MS)
- Practice address
- 830 S Gloster St
4TH Floor East Tower
Tupelo, MS 38801-4934 - Phone
- (662) 377-7170
- Fax
- (662) 377-2423
- NPI assigned
- Oct 13, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- North Mississippi Medical Center, Inc.
Practice addresses (Care Compare)
830 S Gloster
North Ms Med Ctr Sleep Lab
Tupelo, MS 38801-4934
Phone (662) 377-3258
830 S Gloster St
Tupelo, MS 38801-4934
830 S Gloster St 3Rd FL E Tower
Tupelo, MS 38801-4934
Hospital & facility affiliations
- North Mississippi Medical Center
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 |
|---|---|---|---|---|
| I20161109001409 | MS | Practitioner - Nurse Practitioner | 6305125626 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Mississippi Medical Center Inc | Current | Accepting new patients | |
| North Mississippi Medcial Center, Inc. | Current |
Accepting new patients | |
| North Mississippi Medical Center Inc. | Current |
Accepting new patients | |
| North Mississippi Medical Center | Current | Accepting new patients |
Locations
830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136
830 S Gloster St
Fl 4
Tupelo, MS 38801
Phone (662) 377-7100
450 E President Ave
Tupelo, MS 38801
Phone (662) 377-3204
Interoperability endpoints
- robinjackson@nmhs.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 901796 | MS | Yes |
Addresses
Primary practice location
830 S Gloster St
4TH Floor East Tower
Tupelo, MS 38801-4934
Mailing address
450 E President Ave
Tupelo, MS 38801-5599
Phone (662) 377-4685
Other providers in Tupelo, MS
- Emily Hester Jackson
- George Jackson
- Jermie Micheal Jackson
- Jimmy R Jackson
- Robin Jackson
- Russell Earl Jackson
- Valerie Jackson
- Amit Jain
- Jalopy Shoppe, Inc
- Annette C James
All providers in Tupelo, MS · Acute Care 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 Oct 13, 2016. 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.