Individual provider Active NPI

Jessica S. Vaughan, ACNP

  • Acute Care Nurse Practitioner
  • Meridian, MS
National Provider Identifier
1790933752
Registry record updated Mar 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R856479 Issued in MS
Practice address
1314 19TH Ave
Meridian, MS 39301-4116
Phone
(601) 703-4078
Fax
(601) 703-4085
NPI assigned
Sep 3, 2008
Last updated
Mar 1, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R856479 MS Primary

Addresses

Primary practice location

1314 19TH Ave
Meridian, MS 39301-4116

Mailing address

1314 19TH Ave
Meridian, MS 39301-4116
Phone (601) 703-4078

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, AL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20081028000577 MS Practitioner - Nurse Practitioner 7214095710 Reassigns benefits to 1 organization
I20201118000540 AL Practitioner - Nurse Practitioner 7214095710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kemper Cah, Inc.Group PAC ID 5991985012, 28 clinicians

Practice addresses (Care Compare)

1221 N Washington St
Livingston, AL 35470-5410
Phone (205) 652-9575

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R856479MSMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kemper Cah, Inc CurrentSince Nov 1, 2020 Accepting new patients
Medical Foundation, Inc. Acute Care CurrentSince Mar 2, 2011 Accepting new patients
Medical Foundation, Inc. CurrentSince Mar 2, 2011 Accepting new patients
Kemper, Cah, Inc CurrentSince Nov 1, 2020 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

1800 12th St
Meridian, MS 39301
Phone (601) 483-0011

2401 16th St
Meridian, MS 39301
Phone (601) 482-4181

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298937600000",
    "number": "1790933752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 19TH AVE",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014116",
            "telephone_number": "601-703-4078",
            "fax_number": "601-703-4085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 19TH AVE",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014116",
            "telephone_number": "601-703-4078",
            "fax_number": "601-703-4085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "JESSICA",
        "middle_name": "S.",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-03",
        "last_updated": "2011-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R856479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

Verify at the official NPI Registry.