Jacquelyn B Ellison, FNP, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

903206 Issued in MS

Practice address

4105 Hospital Road, Ste 103
Pascagoula, MS 39581

Phone

(228) 762-8712

NPI assigned

Apr 10, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jacquelyn.ellison@ccopp-ms.direct.office.nextgen.com
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Childrens Clinic of Pascagoula PLLC

  • Pediatrics Physician
  • Pascagoula, MS
  • NPI 1750316907
  NPD (past)

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554854400000",
    "number": "1760945448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 MILL STREET EXT",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394523492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 HOSPITAL ROAD, STE 103",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "39581",
            "telephone_number": "228-762-8712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "JACQUELYN",
        "middle_name": "B",
        "credential": "FNP, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-10",
        "last_updated": "2019-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "903206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Chester Egbert, PT
• William R Ehlert, MD
• Okechukwu Ekenna, M.D.
• Camille Tallini Elkins, M.D.
• John C Elkins, CRNP
• Else Tracy, M.D., Inc.
• Renay Danielle Ely Hinkle, FNP-C
• Emergency Room Group LTD
• Matthew Emerick, M.D.
• Daniel J Enger Jr., DDS

• All providers in Pascagoula, MS
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; 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.