NPIMap

Organization Active NPI

Jackson Public Schools Hardy Clinic

  • Registered Nurse
  • Jackson, MS
National Provider Identifier
1720123979
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R557579 Issued in MS
Legal business name
JACKSON PUBLIC SCHOOLS HARDY CLINIC
Practice address
545 Ellis Ave
Jackson, MS 39209-6202
Phone
(601) 960-8705
Fax
(601) 960-8704
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Earl Watkins, PH.D.
Title
Superintendent
Phone
(601) 960-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X R557579 MS Primary

Addresses

Primary practice location

545 Ellis Ave
Jackson, MS 39209-6202

Mailing address

662 S President St
Jackson, MS 39201-5601
Phone (601) 960-8705

Other identifiers 1

IdentifierTypeStateIssuer
04835581MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Jackson Public School District13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

545 Ellis Ave
Jackson, MS 39209
Phone (601) 960-8705

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720123979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "662 S PRESIDENT ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392015601",
            "telephone_number": "601-960-8705",
            "fax_number": "601-960-8704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 ELLIS AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392096202",
            "telephone_number": "601-960-8705",
            "fax_number": "601-960-8704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PUBLIC SCHOOLS HARDY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "EARL",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "601-960-8700",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "R557579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04835581",
            "state": "MS"
        }
    ],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.