Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jackson State University

Organization General Practice Physician · NPI 1366991523

Jackson State University is a General Practice Physician in Jackson, Mississippi. Licensed in Mississippi. Registered with an NPI since 2016.

Licensed in
MS
In the registry since
2016

Practice location Address checks out

1400 Jr Lynch St
Jackson, MS 39217-0002
Phone: (601) 979-2291
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X · Licence 09707 (MS)

Record details

NPI number1366991523
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mouzon Bass — Agent · (972) 367-4845
Other names Jackson State University Sports Medicine
NPI enumeratedSeptember 29, 2016
Last updated in NPPESSeptember 29, 2016
Mailing address5050 Spring Valley Rd, Dallas, TX 75244-3995

Other providers in Jackson