Dominique Mechelle Jackson

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

901975 Issued in MS

Practice address

766B Lakeland Dr
Jackson, MS 39216-4610

Phone

(601) 982-2916

Fax

(601) 366-2916

NPI assigned

May 18, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Garvey Wellness Clinic, IncGroup PAC ID 0042432205, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Garvey Wellness Clinic, Inc.

  • Chiropractor
  • Jackson, MS
  • NPI 1659774701

  Family

  Medicare reassignment Care Compare group NPD
• Pancare of Florida, Inc

  • Community/Retail Pharmacy
  • Panama City, FL
  • NPI 1336704196
  NPD (past)
• Pancare of Florida, Inc

  • Federally Qualified Health Center (FQHC)
  • Panama City, FL
  • NPI 1366456287
  NPD (past)

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

{
    "created_epoch": "1495065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1679000814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "766B LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164610",
            "telephone_number": "601-982-2916",
            "fax_number": "601-366-2916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "766B LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164610",
            "telephone_number": "601-982-2916",
            "fax_number": "601-366-2916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DOMINIQUE",
        "middle_name": "MECHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-18",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "901975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alanda Jackson
• Ashley Jackson
• Catherine Grace Jackson
• Courtney Jackson
• Deriteous Jackson
• J'Messia Jackson
• Janee V Jackson
• Jason Jackson, DO
• Jeremy Don Jackson, M.D.
• Jerra Jackson

• Nurse Practitioner in Jackson, MS
• Providers in Jackson, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.