Individual provider Active NPI

Mary J. St. Pierre, NP

  • Nurse Practitioner
  • Barksdale Afb, LA
National Provider Identifier
1063624716
Registry record updated Jul 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP04153 Issued in LA
Practice address
243 Curtiss Rd
2 MDG/SGHC; Aerospace Medicine; Suite 100
Barksdale Afb, LA 71110-2425
Phone
(318) 456-6131
Fax
(318) 456-6246
NPI assigned
May 4, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP04153 LA Primary

Addresses

Primary practice location

243 Curtiss Rd
2 MDG/SGHC; Aerospace Medicine; Suite 100
Barksdale Afb, LA 71110-2425

Mailing address

FNP
2 MDG/SGHC; Aerospace Medicine; Suite 100
Barksdale Afb, LA 71110-2425
Phone (318) 456-6131

Other identifiers 1

IdentifierTypeStateIssuer
1143723MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP04153LAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ed Physicians of West Louisiana, LLC Nurse Practitioner Past Accepting new patients
Caldwell Memorial Hospital Inc PastSince Mar 9, 2020 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342051200000",
    "number": "1063624716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FNP",
            "address_2": "2 MDG/SGHC; AEROSPACE MEDICINE; SUITE 100",
            "city": "BARKSDALE AFB",
            "state": "LA",
            "postal_code": "711102425",
            "telephone_number": "318-456-6131",
            "fax_number": "318-456-6246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 CURTISS RD",
            "address_2": "2 MDG/SGHC; AEROSPACE MEDICINE; SUITE 100",
            "city": "BARKSDALE AFB",
            "state": "LA",
            "postal_code": "711102425",
            "telephone_number": "318-456-6131",
            "fax_number": "318-456-6246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST. PIERRE",
        "first_name": "MARY",
        "middle_name": "J.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2012-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "AP04153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1143723",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Barksdale Afb, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.