Priscilla Jackson, CFNP
Individual provider Active NPI Nurse Practitioner · Fayette, MS
NPI 1962583971 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1962583971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- R852296 (MS)
- Practice address
- 225 Community Drive
Fayette, MS 39069 - Phone
- (601) 786-8206
- Fax
- (601) 786-6320
- NPI assigned
- Oct 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Jefferson Comprehensive Health Center, Inc.
Practice addresses (Care Compare)
101 Cottage Home Dr
Natchez, MS 39120-2753
Phone (601) 786-3475
Hospital & facility affiliations
- Merit Health Natchez
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140417000800 | MS | Practitioner - Nurse Practitioner | 5597997957 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R852296 | MS | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson Comprehensive Health Center, Inc. | Current |
Accepting new patients | |
| Jefferson Comprehensive Health Center, Inc. | Current |
Accepting new patients | |
| Jefferson Comprehensive Health Center, Inc. | Past | Accepting new patients |
Locations
225 Community Dr
Fayette, MS 39069
Phone (601) 786-2475
101 Cottage Home Dr
Natchez, MS 39120
319 Sgt Prentiss Dr
Natchez, MS 39120
145 Homochitto St
Natchez, MS 39120
Phone (601) 442-4863
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R852296 | MS | Yes |
Addresses
Primary practice location
225 Community Drive
Fayette, MS 39069
Mailing address
21 N Palestine Rd
Natchez, MS 39120-9007
Phone (601) 597-0229
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0121708 | Medicaid | MS | |
| 1783048 | Medicaid | LA |
Other providers in Fayette, MS
- Harmony Hope Haven LLC
- Janecia Herrington
- Sharon Hudson
- Kadeshia Hunt
- Veronica R Hutchins-Clemons
- Veronica Mays Jackson
- Jefferson Comprehensive Health Center Inc
- Jefferson Comprehensive Health Center Inc
- Jefferson Comprehensive Health Center, Inc.
- Jefferson Comprehensive Health Center, Inc.
All providers in Fayette, MS · 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 Jul 8, 2007. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.