ST DOMINIC MEDICAL ASSOCIATES LLC NPI 1508263179

NPI Information

NPI: 1508263179
Provider Name: ST DOMINIC MEDICAL ASSOCIATES LLC

Doing Business As: ST. DOMINIC FAMILY PRACTICE ASSOCIATES-JACKSON

Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
890 LAKELAND DR
JACKSON, MS
ZIP 39216
Phone: (601) 200-3131
Get Directions

ST DOMINIC MEDICAL ASSOCIATES LLC is a family nurse practitioner in Jackson, MS. ST DOMINIC MEDICAL ASSOCIATES LLC NPI is 1508263179. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St. Dominic Family Practice Associates-jackson.

The provider's business location address is:

890 LAKELAND DR
JACKSON, MS
ZIP 39216-644
Phone: (601) 200-3131
Fax: (601) 200-5929

The provider's authorized official is Danielle Stuart .
The authorized official title is Credentialing Representative 2 and has the following contact phone number (601) 200-4880.

The enumeration date for this NPI number is 11/26/2014 and was last updated on 10/18/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	R886071	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	04838265	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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