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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

TIFFANY JACKSON
NPI 1124762794
Nurse Practitioner - Psychiatric/Mental Health in Southaven, MS

Active since April 20, 2022PECOS Enrolled
5875 LANDAU DR, SOUTHAVEN, MS 38671(870) 821-1234 Get Directions Write a Review

NPPES record last updated: September 28, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Sep 28, 2026, Apr 20, 2022 (2 updates tracked since 2022).

About Tiffany Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIFFANY JACKSON (NPI 1124762794) is an individual psychiatric/mental health provider in Southaven, Mississippi, licensed in Indiana (71016838A) and active in the NPI registry since April 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1124762794
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameTIFFANY JACKSON
Location Address5875 LANDAU DRSouthaven, MS 38671-8946
Mailing Address5875 Landau DrSouthaven, MS 38671-8946 · (870) 821-1234
Phone(870) 821-1234
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateApril 20, 2022
Last NPPES UpdateSeptember 28, 20262 updates tracked since enumeration
NPPES CertifiedSeptember 28, 2026
✔ NPI 1124762794 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in IN · 71016838A
5875 LANDAU DR, Southaven, MS 38671
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tiffany Jackson is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2466951942
PECOS Enrollment IDI20250820002207
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 38671 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$80.50 typical visit price
range $51.65 – $159.18
Typical copayment $20.12 (range $12.91 – $39.79)
Most-billed visit code 99203
Established Patient
$92.20 typical visit price
range $16.15 – $129.61
Typical copayment $23.05 (range $4.03 – $32.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tiffany Jackson's NPI number?

The NPI number for Tiffany Jackson is 1124762794. It was assigned to this individual provider in the NPPES registry on April 20, 2022.

Where is Tiffany Jackson located?

Tiffany Jackson practices at 5875 Landau Dr, Southaven, MS 38671. The listed phone number is (870) 821-1234.

What is Tiffany Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Tiffany Jackson enrolled in Medicare?

Yes. Tiffany Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Tiffany Jackson was last updated on September 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.