Mrs Kelly Jarvis Johnson, CPNP - Medicare Nurse Practitioner in Jackson, MS

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Mrs Kelly Jarvis Johnson, CPNP is a medicare enrolled "Nurse Practitioner - Pediatrics, Critical Care" physician in Jackson, Mississippi. Her current practice location is 2500 N State St, Jackson, Mississippi. You can reach out to her office (for appointments etc.) via phone at (601) 815-9291.

Mrs Kelly Jarvis Johnson is licensed to practice in Mississippi (license number 902965) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1578048823.

Contact Information

Mrs Kelly Jarvis Johnson, CPNP
2500 N State St,
Jackson, MS 39216-4500
(601) 815-9291
Not Available

Map and Direction




Physician's Profile

Full NameMrs Kelly Jarvis Johnson
GenderFemale
SpecialityNurse Practitioner - Pediatrics, Critical Care
Location2500 N State St, Jackson, Mississippi
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1578048823
  • Provider Enumeration Date: 10/02/2018
  • Last Update Date: 10/24/2018
  Medicare PECOS Information:
  • PECOS PAC ID: 7719322056
  • Enrollment ID: I20240227001755

Medical Identifiers

Medical identifiers for Mrs Kelly Jarvis Johnson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1578048823NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
208000000XPediatrics 902965 (Mississippi)Secondary
363LP0222XNurse Practitioner - Pediatrics, Critical Care 902965 (Mississippi)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Kelly Jarvis Johnson allows following entities to bill medicare on her behalf.
Entity NameGluckstadt Tc Kids, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1255947297
PECOS PAC ID: 5496160210
Enrollment ID: O20210209000428

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Kelly Jarvis Johnson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Mrs Kelly Jarvis Johnson, CPNP
2500 N State St,
Jackson, MS 39216-4500

Ph: (601) 815-9291		Mrs Kelly Jarvis Johnson, CPNP
2500 N State St,
Jackson, MS 39216-4500

Ph: (601) 815-9291

Reviews and Comments



Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.