Sandra G Russell, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

639834 Issued in MS

Practice address

15 Pumping Station Rd
Petal, MS 39465-8325

Phone

(601) 583-1559

Fax

(601) 583-1573

NPI assigned

Aug 30, 2006

Last updated

Jul 20, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 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

Interoperability endpoints

• Direct secure messaging: srussell2255@directpatientrecord.com

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.

• Hattiesburg Clinic PA

  dba Runnelstown Clinic

  • Family Medicine Physician
  • Petal, MS
  • NPI 1649356767
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595203200000",
    "number": "1932219581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-583-1559",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PUMPING STATION RD",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394658325",
            "telephone_number": "601-583-1559",
            "fax_number": "601-583-1573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "SANDRA",
        "middle_name": "G",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R639834",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "639834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ADMIN GROUP",
            "identifier": "640507572KL",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117682",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1501891",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "srussell2255@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "15 Pumping Station Rd",
            "city": "Petal",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394658325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sarah Rector, LMSW
• Judd M Reynolds, D.O.
• Milton Bradford Reynolds I, DDS
• Shawn Robinson, ATC
• David Bernard Roy, D.O.
• Aaron Rylander, DPT
• Lacey Easterling Saul, R.D
• Coleman Sisson, PHARM. D.
• James Dale Skaggs
• SLM Labs 2

• Family Nurse Practitioner in Petal, MS
• Providers in Petal, 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 Jul 20, 2020; 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.