Organization · Type 2 NPI

ST Dominic Medical Associates LLC

Family Nurse Practitioner · Jackson, MS

NPI number 1508263179 Active

Practice location

890 Lakeland Dr
Jackson, MS 39216-4644

Call (601) 200-3131 Map

Fax (601) 200-5929

Mailing address

PO Box 23666
Jackson, MS 39225-3666

Other practice locations

2050 Treetops Blvd Ste 140, Flowood, MS 39232-7612 · (601) 200-3131
5005 Old Canton Rd, Jackson, MS 39211-5421 · (601) 200-3131

Specialties and licenses

Taxonomy	Code	License
Family Nurse Practitioner Primary	363LF0000X	R886071 (MS)

Family Nurse Practitioner: Definition to come...

3 other providers at this address

Other family nurse practitioner providers in Jackson

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NPI record

NPI: 1508263179
Entity type: Organization (Type 2)
Issued: Nov 26, 2014
Last updated: Oct 18, 2021
Status: Active
Subpart: Yes of ST Dominic Jackson Memorial Hospital

Other names

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St. Dominic Family Practice Associates-Jackson · doing business as

Authorized official

Danielle Stuart
Credentialing Representative 2
(601) 200-4880

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1508263179

ST Dominic Medical Associates LLC's National Provider Identifier is 1508263179, issued on Nov 26, 2014. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Jackson, MS. The record was last updated on Oct 18, 2021.