Active NPI
Darrell Rex Livingston Jr., DMD
- Dentist
- Jackson, MS
National Provider Identifier
1942683149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3802-15
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (662) 379-0033
- NPI assigned
- Jul 7, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3802-15 | MS | Primary |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
2500 N State St
Jackson, MS 39216-4500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181205003554 | MO | Order and Referring Only - Dentist | 8820332653 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3802-15 | MS | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436227200000",
"number": "1942683149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 N STATE ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 N STATE ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164500",
"telephone_number": "662-379-0033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIVINGSTON",
"first_name": "DARRELL",
"middle_name": "REX",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-07",
"last_updated": "2015-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MS",
"license": "3802-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
- Live Oak Psychological Associtaes
- Live Oaks Counseling and Consulting, LLC
- Living in Full Excellence
- Living Independence for Everyone of Mississippi (LIFE of Mississippi)
- Ladean Johnson Livingston Davis, CRNA
- Harold Mark Livingston, D.D.S.
- Livwell Alliance, LLC
- Lloyd B. Wolfe, Jr., D.M.D.
- Jacqueline Lloyd, LPC
- James Victor Nathaniel Lock II
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.