Stephanie Perry Jackson, CFNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R862558 Issued in MS

Practice address

162 Feather LN
Suite E
Canton, MS 39046-8510

Phone

(601) 859-0140

Fax

(601) 510-9643

NPI assigned

Jul 20, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Everycare Express Clinic

  • Clinic/Center
  • Canton, MS
  • NPI 1225433436
  NPD (past) Authorized official

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445299200000",
    "number": "1821097858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 417",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391300417",
            "telephone_number": "601-720-5303",
            "fax_number": "601-510-9643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 FEATHER LN",
            "address_2": "SUITE E",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390468510",
            "telephone_number": "601-859-0140",
            "fax_number": "601-510-9643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEPHANIE",
        "middle_name": "PERRY",
        "name_prefix": "Mrs.",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-20",
        "last_updated": "2015-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R862558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00780035",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Carmell Hubbard, OTD, OTR/L
• Gabriel Martin Ibarra, PA
• Integrated Health Partners, PLLC
• Isd Renal Inc
• Mary Hannah Ivie, MOT, OTR/L
• Valerie Thresa Jackson
• Michelle Marie James, PT
• Janay L Harper DPM PLLC
• James Andrew Jefferson, MD
• Jennifer L Johnson, RN

• Family Nurse Practitioner in Canton, MS
• Providers in Canton, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2015; 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.