Individual ProviderJill NicholasNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address5003 Hardy St, Hattiesburg, MS 39402-1319(601) 296-3530(601) 325-4765PECOS EnrollmentBased on the most recent information from CMS, provider Jill Nicholas is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1295288033Provider TypeIndividualFull NameNicholas, JillCredentialNP-CGenderFemaleSole ProprietorNoEnumeration Date7/28/2016Last Updated4/28/2017Contact InformationPractice LocationPractice Address5003 Hardy St, Hattiesburg, MS 39402-1319Phone(601) 296-3530FaxUnlisted FaxMailing LocationMailing Address391 Sandhill Rd, Ellisville, MS 39437-8423Phone(601) 325-4765FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR881571Mississippi