MRS. KELLY JARVIS JOHNSON CPNP
NPI 1578048823
Nurse Practitioner - Pediatrics, Critical Care in Jackson, MS
About Mrs. Kelly Jarvis Johnson Cpnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. KELLY JARVIS JOHNSON CPNP (NPI 1578048823) is an individual pediatrics, critical care provider in Jackson, Mississippi, licensed in Mississippi (902965) and active in the NPI registry since October 2018. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mrs. Kelly Jarvis Johnson Cpnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Kelly Johnson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Jackson, MS 39216
- Reassigned Medicare billing, Mississippi enrollment
- 1,932 clinicians in this Medicare group
Madison, MS 39110
- Reassigned Medicare billing, Mississippi enrollment
- 36 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 39216 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
JACKSON, MS 39216
JACKSON, MS 39216
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 Kelly Johnson's NPI number?
The NPI number for Kelly Johnson is 1578048823. It was assigned to this individual provider in the NPPES registry on October 2, 2018.
Where is Kelly Johnson located?
Kelly Johnson practices at 2500 N State St, Jackson, MS 39216. The listed phone number is (601) 815-9291.
What is Kelly Johnson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, Critical Care, with taxonomy code 363LP0222X.
Is Kelly Johnson enrolled in Medicare?
Yes. Kelly Johnson is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Kelly Johnson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Johnson reassigns Medicare benefits to 2 organizations: State Of Mississippi - University Of Mississippi Medical Center (Jackson, MS) and Gluckstadt Tc Kids, LLC (Madison, MS). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Johnson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kelly Johnson accept?
Health plans from Molina Healthcare and Oscar Health Plan, Inc. list Kelly Johnson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Kelly Johnson was last updated on October 24, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Mrs. Kelly Jarvis Johnson, CPNP · NPI 1578048823
Pediatrics, Critical Care physician in Jackson, Mississippi. Individual provider, active in the CMS NPPES registry since October 2, 2018.
## Identity
- **NPI:** 1578048823 (Entity type: Individual)
- **Enumerated:** October 2, 2018
- **Primary specialty:** Nurse Practitioner - Pediatrics, Critical Care · taxonomy 363LP0222X
- **State license:** 902965 (Mississippi)
- **Sole proprietor:** No
## Practice location
- **Address:** 2500 N STATE ST, Jackson, MS 39216-4500
- **Phone:** (601) 815-9291
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): State Of Mississippi - University Of Mississippi Medical Center (NPI 1154317527, Jackson, MS); Gluckstadt Tc Kids, LLC (NPI 1255947297, Madison, MS) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 24, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1578048823) · Data from the CMS NPPES public registry.