Jessica S. Vaughan, ACNP
Individual provider Active NPI Acute Care Nurse Practitioner · Meridian, MS
NPI 1790933752 · NPPES record last updated Mar 1, 2011
Key facts
- NPI
- 1790933752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acute Care Nurse Practitioner 363LA2100X
- License
- R856479 (MS)
- Practice address
- 1314 19TH Ave
Meridian, MS 39301-4116 - Phone
- (601) 703-4078
- Fax
- (601) 703-4085
- NPI assigned
- Sep 3, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kemper Cah, Inc.
Practice addresses (Care Compare)
1221 N Washington St
Livingston, AL 35470-5410
Phone (205) 652-9575
Hospital & facility affiliations
- Aveanna Home Health
- Amedisys Home Health of Selma
- Ochsner Rush Hospital
- Ochsner Stennis Memorial Hospital
- Whitfield Regional Hospital
- DCH Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, AL
- 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 |
|---|---|---|---|---|
| I20081028000577 | MS | Practitioner - Nurse Practitioner | 7214095710 | Reassigns benefits to 1 organization |
| I20201118000540 | AL | Practitioner - Nurse Practitioner | 7214095710 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R856479 | MS | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Foundation, Inc. | Current |
Accepting new patients | |
| Medical Foundation, Inc. | Acute Care | Current |
Accepting new patients |
| Kemper, Cah, Inc | Current |
Accepting new patients | |
| Kemper Cah, Inc | Current |
Accepting new patients | |
| Kemper Cah, Inc. | Past | Accepting new patients |
Locations
1221 N Washington St
Livingston, AL 35470
Phone (205) 652-7680
1314 19th Ave
Meridian, MS 39301
Phone (601) 483-0011
2401 16th St
Meridian, MS 39301
Phone (601) 482-4181
1800 12th St
Meridian, MS 39301
Phone (601) 483-0011
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | R856479 | MS | Yes |
Addresses
Primary practice location
1314 19TH Ave
Meridian, MS 39301-4116
Mailing address
1314 19TH Ave
Meridian, MS 39301-4116
Phone (601) 703-4078
Other providers in Meridian, MS
- Danni Upperman
- Urology Clinic of Meridian, P.a.
- James Lee Valentine
- Ashley Vandewalker
- Pablo 'Paul' Y. Varela
- Chadley T Vega
- Courtney Vermillion
- Alexandria Allen Vincent
- Lesley Robinson Vincent
- Richard M. Vise
All providers in Meridian, 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 Mar 1, 2011. 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.