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

Kodi Long Jackson, PA

Individual provider Physician Assistant · NPI 1588373716

Kodi Long Jackson, PA is a Physician Assistant in Jackson, Mississippi. Qualified in 2022, 4 years ago. Practices with St Dominic Medical Associates LLC, a 127-clinician group, works from 3 locations and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2022
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

969 Lakeland Dr
Jackson, MS 39216-4606
Phone: (601) 200-3631
Fax: (601) 200-0159
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 971 Lakeland Dr Ste 356, Jackson, MS 39216-4607 — (601) 200-4644
  • 971 Lakeland Dr Ste 657, Jackson, MS 39216-4608 — (601) 200-2780

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1588373716
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedNovember 16, 2022
Last updated in NPPESNovember 3, 2025
Certification dateNovember 3, 2025
Mailing address5959 S Sherwood Forest Blvd, Baton Rouge, LA 70816-6038

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice St. Dominic Medical Associates Llc — 127 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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