Individual provider Active NPI

Jessica Patterson Koon

  • Nurse Practitioner
  • Saltillo, MS
National Provider Identifier
1871464040
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2025046474 Issued in MS
Practice address
1663 Birmingham Ridge Rd
Saltillo, MS 38866-6819
Phone
(662) 377-5199
NPI assigned
Sep 12, 2025
Last updated
Oct 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2025046474 MS Primary

Addresses

Primary practice location

1663 Birmingham Ridge Rd
Saltillo, MS 38866-6819

Mailing address

1663 Birmingham Ridge Rd
Saltillo, MS 38866-6819
Phone (662) 377-5199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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 1

Enrollment IDStateProvider typePAC IDDetails
I20251121001975 MS Practitioner - Nurse Practitioner 7315439957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4381 S Eason Blvd
North Mississippi Regional Pain Con
Tupelo, MS 38801-6583
Phone (662) 377-5199

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2025046474MSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center CurrentSince Oct 15, 2025 Accepting new patients
North Mississippi Medcial Center, Inc. CurrentSince Oct 15, 2025 Accepting new patients
North Mississippi Medical Center Inc Current Accepting new patients

Locations

4381 S Eason Blvd
Tupelo, MS 38801
Phone (662) 377-5199

4381 S Eason Blvd
Ste 101
Tupelo, MS 38801
Phone (662) 377-4054

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

Organizations & group practices 3

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 1

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": "1757635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1871464040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1663 BIRMINGHAM RIDGE RD",
            "city": "SALTILLO",
            "state": "MS",
            "postal_code": "388666819",
            "telephone_number": "662-377-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1663 BIRMINGHAM RIDGE RD",
            "city": "SALTILLO",
            "state": "MS",
            "postal_code": "388666819",
            "telephone_number": "662-377-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOON",
        "first_name": "JESSICA",
        "middle_name": "PATTERSON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-12",
        "last_updated": "2025-10-24",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "2025046474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saltillo, MS

Sources for this page

Verify at the official NPI Registry.