JACKSON STATE UNIVERSITY (NPI# 1366991523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366991523 |
| Entity Type | Organization |
| Organization Name | JACKSON STATE UNIVERSITY |
| Other Organization Name | JACKSON STATE UNIVERSITY SPORTS MEDICINE |
| Practice Address |
1400 Jr Lynch St Jackson MS 39217-0002 |
| Mailing Address |
5050 Spring Valley Rd Dallas TX 75244-3995 |
| Practice Telephone | 6019792291 |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2016-09-29 |
| Authorized Official Name | MOUZON BASS III (AGENT) |
| Authorized Official Telephone | 9723674845 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 09707 | MS | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Jackson State University Sports Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023285046 | Jackson State University | Social Worker | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2008-05-08 |
| Street Address |
1400 JR LYNCH ST |
| City | JACKSON |
| State | MS |
| Zip Code | 39217-0002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275028193 | Jacqueline Reese-smith | Psychologist | 1400 J. R. Lynch Street, Department of Psychology, Jackson, MS 39217 | 2018-06-22 |
| 1831281922 | Latoya Cordrellia Johnson | Counselor | 1500 E Woodrow Wilson Dr, Jackson, MS 39217-0001 | 2006-09-28 |
| 1972620375 | Fredrick L. Robinson | Specialist/Technologist | 1400 J R Lynch St, Jackson, MS 39217-0002 | 2007-03-23 |
| 1215292057 | Ollie Loraine Harper | Clinic/Center | 1400 J R Lynch St, Jackson, MS 39217-0002 | 2012-07-09 |
| 1316101611 | Lorna Shird | Psychologist | 1400 J R Lynch St, Department of Psychology, Jackson, MS 39217-0002 | 2008-07-15 |
| 1205289659 | Jaspreet Kaur Oberoi | Student in an Organized Health Care Education/Training Program | 2500 N State St, Jackson, MS 39217-2608 | 2016-07-21 |
| 1750860755 | Tiffany Ciara Smith | Nurse Practitioner | 1400 J R Lynch St, Jackson, MS 39217-5511 | 2018-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447851407 | Rebecca Lynn Collimore | Student in an Organized Health Care Education/Training Program | 5 Twin Oaks Ct, Jackson, NJ 08527-5359 | 2020-11-05 |
| 1902407067 | Mjp Management LLC | In Home Supportive Care | 1 Comtronics Pl, Jackson, MI 49203-7500 | 2020-11-05 |
| 1457952665 | John Cate Owen | Counselor | 2525 Lakeward Dr Ste 400, Jackson, MS 39216-4827 | 2020-11-04 |
| 1326649740 | Madison Mcbride | Occupational Therapist | 442 Redmond St, Jackson, WY 83001-8451 | 2020-11-03 |
| 1013518430 | Millie Mitchell | Social Worker | 321 Woodland Dr, Jackson, AL 36545-2438 | 2020-11-03 |
| 1508467986 | Calvin Walker | Social Worker | 138 Prince Edward St, Jackson, TN 38301-5316 | 2020-11-03 |
| 1922609288 | Kristen Nicole Frank | Physical Therapist | 2290 W County Line Rd Ste 215, Jackson, NJ 08527-2267 | 2020-11-03 |
| 1104427780 | Ronald Dwayne Woods | Dietitian, Registered | 1 Ashton Gardens Dr, Jackson, MS 39211-4275 | 2020-11-02 |
| 1154922789 | Linda Vaughn | Technician | 5433 State Route 139, Jackson, OH 45640-9271 | 2020-11-02 |
| 1073113627 | Jessicah Blasdel | Nurse Practitioner | 113 W Michigan Ave, Jackson, MI 49201-1340 | 2020-10-31 |
| Find all providers in JACKSON | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124475371 | Donald Lafont | General Practice | 331 Edenwood Dr, Jackson, TN 38301-3432 | 2016-05-18 |
| 1669717302 | Lift Wellness Inc | General Practice | 101 Jackson Walk Plaza, Jackson, TN 38301 | 2012-12-06 |
| 1457665333 | Teton County Hospital District | General Practice | Box 428 625 E Broadway Ave, Jackson, WY 83001-8642 | 2010-08-03 |
| 1851524730 | Byrd Lamar Payne | General Practice | 1205 Lyncrest Ave, Jackson, MS 39202-2106 | 2009-08-26 |
| 1801031703 | Total Spine Surgical Center LLC | General Practice | 1455 College Ave, Jackson, AL 36545-2410 | 2008-12-05 |
| 1992974018 | Visiting Doctors PC | General Practice | 2108 4th St Ste A, Jackson, MI 49203-4518 | 2008-02-22 |
| 1821127093 | Peter Thomas Gardner | General Practice | 2075 Pleasant Plains Ext Rd, Jackson, TN 38305-6087 | 2007-03-05 |
| 1154491579 | Bruce Hayse | General Practice | 269 West Broadway, Jackson, WY 83001-1884 | 2006-11-09 |
| 1104880558 | Lorna Gaye Pinson | General Practice | 3235 East Michigan Ave, Jackson, MI 49202 | 2006-04-13 |
| 1639146814 | Melanie Hoppers | General Practice | 2075 Pleasant Plains Extended, Jackson, TN 38305 | 2006-03-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.