Jerrilyn Diane Adkisson

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Practice address

208 N Ingram Rd
Sikeston, MO 63801-5233

Phone

(573) 471-3770

NPI assigned

Dec 3, 2018

Last updated

Dec 3, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

Practice roles

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.

• Paradise Group Home LLC

  • Point of Service
  • Risco, MO
  • NPI 1497210629
  NPD (past) Authorized official
• Paradise Home Services, LLC

  • Home Health Agency
  • Scott City, MO
  • NPI 1417502261
  NPD (past) Authorized official

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543795200000",
    "number": "1922578996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 N INGRAM RD",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015233",
            "telephone_number": "573-471-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 N INGRAM RD",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015233",
            "telephone_number": "573-471-3770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 Front Street",
            "address_purpose": "LOCATION",
            "city": "Risco",
            "state": "MO",
            "postal_code": "63874",
            "country_code": "US",
            "telephone_number": "573-394-5020",
            "fax_number": "573-394-5022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "802 Courtney Dr",
            "address_purpose": "LOCATION",
            "city": "Sikeston",
            "state": "MO",
            "postal_code": "638013215",
            "country_code": "US",
            "telephone_number": "573-471-3770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADKISSON",
        "first_name": "JERRILYN",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-03",
        "last_updated": "2018-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI SECRETARY OF STATE",
            "identifier": "LC001488560",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1063620565",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Point of Service in Sikeston, MO
• Providers in Sikeston, MO by specialty
• Point of Service in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2018; 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.