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

Jason Keith Ely

Individual provider Family Nurse Practitioner · NPI 1104595396

Jason Keith Ely is a Nurse Practitioner in Gulfport, Mississippi. Qualified in 2021, 5 years ago. Practices with Cooper Family Medical Center Inc, a 2-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
5
Licensed in
MS
In the registry since
2021
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Practice location Address checks out

15190 Community Rd Ste 260
Gulfport, MS 39503-3471
Phone: (228) 762-4483
Fax: (228) 762-3147
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 9048725 (MS)

Record details

NPI number1104595396
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 10, 2021
Last updated in NPPESMay 2, 2022
Certification dateMay 2, 2022

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Cooper Family Medical Center Inc. — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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