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

Glenn A Pederson

Individual provider Nurse Practitioner · NPI 1811171408

Glenn A Pederson is a Nurse Practitioner in Jackson, Mississippi. Qualified in 1994, 32 years ago. Practices with Paragon Emergency Services LLC, a 406-clinician group and accepts Medicare assignment. Licensed in Florida and Mississippi.

Years since qualifying
32
Licensed in
FL, MS
In the registry since
2007
Specialties on file
2
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Practice location Address checks out

1850 Chadwick Dr
Jackson, MS 39204-3404
Phone: (601) 376-2944
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence R878258 (MS)
Emergency Medicine Physician Taxonomy 207P00000X · Licence ARNP1604312 (FL)

Record details

NPI number1811171408
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 19, 2007
Last updated in NPPESJuly 9, 2010
Mailing address18167 Us Highway 19 N, Suite 285, Clearwater, FL 33764-3528

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 1994 (32 years in practice)
Group practice Paragon Emergency Services Llc — 406 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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