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ST. DOMINIC FAMILY PRACTICE ASSOCIATES-JACKSON
NPI 1508263179
Nurse Practitioner - Family in Jackson, MS

Active since November 26, 2014
890 LAKELAND DR, JACKSON, MS 39216(601) 200-3131(601) 200-5929 Get Directions Write a Review

NPPES record last updated: October 18, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 18, 2021, Apr 14, 2021, May 10, 2019 (3 updates tracked since 2019).

About St. Dominic Family Practice Associates-jackson NPPES

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

ST. DOMINIC FAMILY PRACTICE ASSOCIATES-JACKSON (NPI 1508263179) is a healthcare organization registered as a family in Jackson, Mississippi and active in the NPI registry since November 2014. The organization maintains 2 additional practice locations and lists Danielle Stuart, Credentialing Representative 2, as its authorized official.

NPPES Registry Identity

NPI1508263179
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameST DOMINIC MEDICAL ASSOCIATES LLC
Location Address890 LAKELAND DRJackson, MS 39216-4644
Mailing AddressPo Box 23666Jackson, MS 39225-3666 · (601) 200-3131 · Fax (601) 200-0710
Phone(601) 200-3131
Fax(601) 200-5929
Organization SubpartYesParent: St Dominic Jackson Memorial Hospital
Authorized OfficialDanielle StuartCredentialing Representative 2 · (601) 200-4880
Enumeration DateNovember 26, 2014
Last NPPES UpdateOctober 18, 20213 updates tracked since enumeration
NPPES CertifiedOctober 18, 2021
✔ NPI 1508263179 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in MS · R886071
890 LAKELAND DR, Jackson, MS 39216
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Other Names 1

Doing Business AsSt. Dominic Family Practice Associates-jackson

Secondary Practice Locations 2

Location 15005 Old Canton RdJackson, MS 39211-5421 · Phone (601) 200-3131 · Fax (601) 200-3109
Location 22050 Treetops Blvd Ste 140Flowood, MS 39232-7612 · Phone (601) 200-3131 · Fax (601) 200-3109

Other Identifiers 1

Medicaid04838265MS

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GUY T. VISE JR., M.D.
Specialist
890 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 366-5998
JORDAN EILAND MORRIS NP
Nurse Practitioner (Family)
890 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 200-3131
MRS. AMANDA WYNNE ATWOOD CFNP
Nurse Practitioner (Family)
890 LAKELAND DR
JACKSON, MS 39216
Hinds County (601) 200-3131

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 St Dominic Medical Associates LLC's NPI number?

The NPI number for St Dominic Medical Associates LLC is 1508263179. It was assigned to this organization in the NPPES registry on November 26, 2014. The provider is doing business as St. Dominic Family Practice Associates-Jackson.

Where is St Dominic Medical Associates LLC located?

St Dominic Medical Associates LLC is located at 890 Lakeland Dr, Jackson, MS 39216. The listed phone number is (601) 200-3131.

What is St Dominic Medical Associates LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for St Dominic Medical Associates LLC was last updated on October 18, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.