Denetta Ross, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Jackson, MS
NPI 1992149348 · NPPES record last updated Dec 17, 2013
Key facts
- NPI
- 1992149348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R868748 (MS)
- Practice address
- 5429 Robinson Road Ext
Jackson, MS 39204-4138 - Phone
- (601) 914-0163
- NPI assigned
- Apr 28, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Central Mississippi Health Services, Inc
Practice addresses (Care Compare)
5429 Robinson Rd Ext
Jackson, MS 39204-4138
Phone (601) 914-0163
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 |
|---|---|---|---|---|
| I20140320000973 | MS | Practitioner - Nurse Practitioner | 6002047834 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R868748 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Mississippi Health Services, Inc | Current | Accepting new patients | |
| Central Mississippi Health Services, Inc | Current |
Accepting new patients | |
| Central Mississippi Health Services, Inc | Current |
Accepting new patients |
Locations
5429 Robinson Road Ext
Jackson, MS 39204
Phone (601) 914-0163
1134 Winter St
Jackson, MS 39204
Phone (601) 948-5572
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R868748 | MS | Yes |
Addresses
Primary practice location
5429 Robinson Road Ext
Jackson, MS 39204-4138
Mailing address
5429 Robinson Road Ext
Jackson, MS 39204-4138
Other providers in Jackson, MS
- Claire Brabec Rosenblatt
- Martin Anders Rosengreen
- Ekaterina Roshchina
- Ajuanzie Lucianna Ross
- Brendan Sean Ross
- Ferderrick Ross
- Jane Ross
- Joe R. Ross
- Kandace Ross
- Leah Pritchard Ross
All providers in Jackson, 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 Dec 17, 2013. 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.