Primesource Nursing Services, Inc
Organization Active NPI Family Nurse Practitioner · Gulfport, MS
NPI 1962573170 · NPPES record last updated Jun 8, 2026
Key facts
- NPI
- 1962573170
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 7381 (MS)
- Legal business name
- PRIMESOURCE NURSING SERVICES, INC
- Practice address
- 1822 15TH St Ste a
Gulfport, MS 39501-2104 - Phone
- (228) 865-1330
- Fax
- (228) 865-1331
- NPI assigned
- Nov 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Jana Plauche, RN
- Title
- Vice President
- Phone
- (228) 865-1330
Other NPIs on the same Medicare enrollment 1
Practitioners 10
-
Jennifer S Brechtel, PMHNP-BC
-
Lucy B Hodges, FPNP
-
Lauren Renee Jandorf, FNP-C
-
Kelly Lynn Tinson, NP-C
-
Phillip D Compton II, M.D.
-
Jennifer Leigh Galle, NP-C
-
Jeri Hughes Squyres, LCSW
-
Chad Bailey, FNP
-
Allyson Delaune, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050429000745 | MS | Part B Supplier - Clinic/Group Practice | 7113966037 |
Receives reassigned benefits from 6 practitioners 1 other NPI on this enrollment Practice locations: Gulfport, MS; Biloxi, MS |
National Provider Directory
Locations
38 Pass Rd
Ste A
Gulfport, MS 39507
Phone (228) 864-3300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | |||
| Family Nurse Practitioner |
363LF0000X | 7381 | MS | Yes |
Addresses
Primary practice location
1822 15TH St Ste a
Gulfport, MS 39501-2104
Mailing address
PO Box 6705
Gulfport, MS 39506-6705
Phone (228) 865-1330
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06550237 | Medicaid | MS |
Other providers in Gulfport, MS
- Kathryn E Price
- Kayla Elise Price
- Primary Care Medical Center of Gulfport, PLLC
- Primesource Nursing Services, Inc
- Primesource Nursing Services, Inc
- Tanisha Nedelka Prins
- Sally M Proffitt
- Prosthetic Solutions Inc.
- Laura Puffer
- Robert Pullens
All providers in Gulfport, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.