NPIMap

Individual provider Active NPI

Katina Grant, FNP-C

  • Primary Care Nurse Practitioner
  • Canton, MS
National Provider Identifier
1851879126
Registry record updated Jul 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
902801 Issued in MS
Practice address
122 E Academy St
Canton, MS 39046
Phone
(601) 859-8992
NPI assigned
Jul 30, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 902801 MS Primary

Addresses

Primary practice location

122 E Academy St
Canton, MS 39046

Mailing address

122 E Academy St
Canton, MS 39046-4502
Phone (601) 859-8992

Other practice location 1

170 Sivley Ave
Jackson, MS 39203-2064
Phone (601) 826-1325

Other practice location 2

170 Sivley Ave
Jackson, MS 39203-2064
Phone (601) 826-1325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181005000054 MS Practitioner - Nurse Practitioner 0648522433 Reassigns benefits to 3 organizations
Practice locations: Canton, MS

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1410 E Woodrow Wilson Dr
Umc Pavilion
Jackson, MS 39216-5197
Phone (601) 815-2005

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
902801MSMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Strategic Solutions-Panola Medical Center LLC Current Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince Oct 30, 2019 Accepting new patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
State of Mississippi-University of Mississippi Medical Center CurrentSince Nov 9, 2024 Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince Oct 30, 2019 Accepting new patients
Strategic Solutions-Panola Medical Center LLC CurrentSince Jun 1, 2021 Accepting new patients
Strategic Solutions-Panola Medical Center LLC CurrentSince Jun 1, 2021 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Nov 9, 2024 Accepting new patients

Locations

303 Medical Center Dr
Batesville, MS 38606
Phone (662) 563-0155

255 Medical Center Dr
Batesville, MS 38606
Phone (662) 563-2163

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

1410 E Woodrow Wilson Ave
Jackson, MS 39216
Phone (601) 815-4775

517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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": "1532908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532995200000",
    "number": "1851879126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E ACADEMY ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390464502",
            "telephone_number": "601-859-8992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E ACADEMY ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "39046",
            "telephone_number": "601-859-8992"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "170 Sivley Ave",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392032064",
            "country_code": "US",
            "telephone_number": "601-826-1325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "170 Sivley Ave",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392032064",
            "country_code": "US",
            "telephone_number": "601-826-1325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRANT",
        "first_name": "KATINA",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-30",
        "last_updated": "2018-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "902801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MS

Sources for this page

Verify at the official NPI Registry.