JACKSON NEUROCARE, PLLC (NPI# 1770987638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770987638 |
| Entity Type | Organization |
| Organization Name | JACKSON NEUROCARE, PLLC |
| Practice Address |
971 Lakeland Drive Suite 557, West Tower Jackson MS 39216-4607 |
| Practice Telephone | 6019390361 |
| Practice Fax Number | 6019395210 |
| Mailing Telephone | 6019390361 |
| Mailing Fax Number | 6019395210 |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2014-10-21 |
| Authorized Official Name | MRS. RUTH KELLUM FREDERICKS (OWNER) |
| Authorized Official Telephone | 6019390361 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
11722 | MS | Allopathic & Osteopathic Physicians |
| Street Address |
971 LAKELAND DRIVE SUITE 557, WEST TOWER |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477563104 | Amanda Reagan Schiefer | Internal Medicine | 971 Lakeland Drive, Jackson, MS 39126 | 2006-08-08 |
| 1326562968 | Stephanie Nichole Love | Nurse Practitioner | 971 Lakeland Drive, Suite 401 East Tower, Jackson, MS 39216 | 2017-07-26 |
| 1295117505 | Anna Marie Ketchum | Nurse Practitioner | 971 Lakeland Drive, Ste 1052, Jackson, MS 39216 | 2015-06-23 |
| 1023323029 | Vanessa L. Sandifer, M.d., Pllc | Internal Medicine | 971 Lakeland Drive, Suite 450, Jackson, MS 39216-0450 | 2010-08-13 |
| 1780902155 | Raymond F. Grenfell, IIi., M.d., Pllc | Internal Medicine | 971 Lakeland Drive, Suite 450, Jackson, MS 39216 | 2010-05-11 |
| 1346370921 | Muscle and Nerve Pa | Psychiatry & Neurology | 971 Lakeland Drive, Suite 560, Jackson, MS 39216 | 2007-03-06 |
| 1700911096 | Donald L Seago | Dentist | 971 Lakeland Drive, Suite 225, Jackson, MS 39216-4643 | 2007-02-23 |
| 1316089634 | David E Seago | Dentist | 971 Lakeland Drive, Suite 225, Jackson, MS 39216-4643 | 2007-02-13 |
| 1427190750 | Stephen R Gandy | Dentist | 971 Lakeland Drive, Suite 225, Jackson, MS 39216-4643 | 2007-02-13 |
| 1285781153 | Berthrone Lacalvin Mock-muhammad | Internal Medicine | 971 Lakeland Drive, Jackson, Jackson, MS 39216-4608 | 2007-01-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235454059 | Mitchell Myers, M.d. | Psychiatry & Neurology | 2906 North State Street, Suite 301, Jackson, MS 39216 | 2010-04-05 |
| 1477745842 | Catherine Haynes Wuthrich | Psychiatry & Neurology | 2092 Lilac Lane, Jackson, WY 83002 | 2007-08-09 |
| 1003907460 | Patrick E Weldon | Psychiatry & Neurology | 1860 Chadwick Drive, Suite 258, Jackson, MS 39204 | 2006-09-28 |
| 1801991401 | James H Spruill Jr. | Psychiatry & Neurology | 614 Skyline Dr, Jackson, TN 38301-3923 | 2006-09-14 |
| 1174628903 | Michael W Brueggeman | Psychiatry & Neurology | 700 West Forest, Ste 200, Jackson, TN 38301 | 2006-09-14 |
| 1417962952 | Mohamad R Karami-sichani | Psychiatry & Neurology | 50 Bent Creek Ln, Jackson, TN 38305-2170 | 2006-07-31 |
| 1760427496 | Sumathira T Sathanandan | Psychiatry & Neurology | 700 West Forest, Ste. 200, Jackson, TN 38301 | 2006-06-17 |
| 1174574701 | Kathleen A. Messenger | Psychiatry & Neurology | 971 Lakeland Dr Ste 557, Jackson, MS 39216-4661 | 2006-05-16 |
| 1669430708 | Aida Bodour | Psychiatry & Neurology | 1400 E Michigan Ave, Jackson, MI 49202-3518 | 2006-05-01 |
| 1891751806 | Umesh Verma | Psychiatry & Neurology | 1418 E Michigan Ave, Jackson, MI 49202-3518 | 2006-04-26 |
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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.