JACK CHANDLER PAPA NPI 1922615616

NPI Information

NPI: 1922615616
Provider Name: JACK CHANDLER PAPA
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: SPECIALTY PHYSICIAN GROUP LLC

PECOS Registration: Yes

Address:
3556 MAY BROOK CV
SOUTHAVEN, MS
ZIP 38672
Phone: (901) 610-8125
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Jack Chandler Papa is a family nurse practitioner in Southaven, MS with 4 years of experience. Jack Chandler Papa NPI is 1922615616. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3556 MAY BROOK CV
SOUTHAVEN, MS
ZIP 38672-006
Phone: (901) 610-8125

The NPI 1922615616 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/26/2020 and was last updated on 12/1/2020.

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	904282	MISSISSIPPI	No
2	363LF0000X	Nurse Practitioner	Family	PAPA-03IX09	MISSISSIPPI	No
3	363LF0000X	Nurse Practitioner	Family	28410	TENNESSEE	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	904282	OTHER	MISSISSIPPI	MS LICENSE
2	APN0000028410	MEDICAID	TENNESSEE

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: 11/14/2023

NPI Synchronization or Removal

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