Jeannine A Racey, CGNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

R725927 Issued in MS

Practice address

1530 Broad Ave
Gulfport, MS 39501-3601

Phone

(228) 865-1330

Fax

(228) 865-1331

NPI assigned

Jul 14, 2006

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299715200000",
    "number": "1891711784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6705",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395066705",
            "telephone_number": "228-865-1330",
            "fax_number": "228-865-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395013601",
            "telephone_number": "228-865-1330",
            "fax_number": "228-865-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACEY",
        "first_name": "JEANNINE",
        "middle_name": "A",
        "credential": "CGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2011-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MS",
            "license": "R725927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00342756",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02858597",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fauzia F. Quddus, M.D.
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• Barry Michael Quirk Jr., DPT
• R Kimble Doty, Jr DDS,Ms Pediatric Dentistry, PC
• Rita A Rademacher, LMSW
• Tisha Nicole Radich, COTA/L
• Raeline K. McIntyre, DMD, P.C.
• Harmony Raffeo
• Ashlyn Victoria Rager, BCBA

• Gerontology Nurse Practitioner in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Gerontology Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; 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.