Individual provider Active NPI

Katie Lianne Jubala, FNP-C

  • Nurse Practitioner
  • Shreveport, LA
National Provider Identifier
1063043271
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
21224 Issued in LA
Practice address
1501 Kings Hwy
Shreveport, LA 71103-4228
Phone
(318) 675-6153
Fax
(318) 675-8081
NPI assigned
Jan 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 21224 LA Primary
Adult Medicine Physician 207QA0505X AP144824 TX

Addresses

Primary practice location

1501 Kings Hwy
Shreveport, LA 71103-4228

Mailing address

1501 Kings Hwy
PO Box 33932
Shreveport, LA 71103-4228
Phone (318) 675-6153

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200827002724 LA Practitioner - Nurse Practitioner 0143647750 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1541 Kings Hwy
Shreveport, LA 71103-4228
Phone (318) 675-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP144824TXMDAdult Medicine Physician
21224LAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lsu Health Sciences Center Shreveport Faculty Group Practice CurrentSince Aug 21, 2020 Accepting new patients

Locations

1501 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0434

1405 Kings Hwy
Shreveport, LA 71103
Phone (318) 813-1000

1606 Kings Hwy
Shreveport, LA 71103
Phone (318) 675-6402

1512 W Kirby Pl
Shreveport, LA 71103
Phone (318) 626-0177

1541 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0287

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1063043271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "PO BOX 33932",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-6153",
            "fax_number": "318-675-8081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-6153",
            "fax_number": "318-675-8081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUBALA",
        "first_name": "KATIE",
        "middle_name": "LIANNE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-28",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "21224",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": "AP144824",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.