Active NPI
Irma Jackson
- Women's Health Nurse Practitioner
- Greenville, MS
National Provider Identifier
1992845226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- R511587
- Practice address
- 1633 Hospital St
Greenville, MS 38703-3222 - Phone
- (662) 332-8177
- Fax
- (662) 378-3783
- NPI assigned
- Feb 7, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | R511587 | MS | Primary |
Addresses
Primary practice location
1633 Hospital St
Greenville, MS 38703-3222
Mailing address
1633 Hospital St
Greenville, MS 38703-3222
Phone (662) 332-8177
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00123993 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1992845226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1633 HOSPITAL ST",
"city": "GREENVILLE",
"state": "MS",
"postal_code": "387033222",
"telephone_number": "662-332-8177",
"fax_number": "662-378-3783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1633 HOSPITAL ST",
"city": "GREENVILLE",
"state": "MS",
"postal_code": "387033222",
"telephone_number": "662-332-8177",
"fax_number": "662-378-3783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "IRMA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-07",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "MS",
"license": "R511587",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00123993",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.