Jefferson Street Primary Care Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

JEFFERSON STREET PRIMARY CARE CLINIC

Practice address

618 Jefferson Blvd
Lafayette, LA 70501-7206

Phone

(337) 345-1709

Fax

(337) 345-4221

NPI assigned

May 28, 2025

Last updated

Feb 11, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Antoinette Rabenaldt

Title

Credentialing Coordinator/HR

Phone

(337) 330-2576

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Myisha Sanae Johnson-Ledet, FNP-C

  • Family Nurse Practitioner
  • Lafayette, LA
  • NPI 1013520774
  Medicare reassignment NPD

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

{
    "created_epoch": "1748390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770768000000",
    "number": "1124811450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 HACKER ST",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705604508",
            "telephone_number": "337-330-2576",
            "fax_number": "337-417-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 JEFFERSON BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705017206",
            "telephone_number": "337-345-1709",
            "fax_number": "337-345-4221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON STREET PRIMARY CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-28",
        "last_updated": "2026-02-11",
        "certification_date": "2026-02-11",
        "status": "A",
        "authorized_official_last_name": "RABENALDT",
        "authorized_official_first_name": "ANTOINETTE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR/HR",
        "authorized_official_telephone_number": "337-330-2576"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Todd Jeansonne, FNP
• Crystal White Jeansonne, FNP
• Jefferson Drug Pharmacy
• Jefferson Pharmacy,LLC
• Jefferson Street Clinic LLC (Jefferson Street Clinic)
• Emmett Jefferson III
• Kelsey R Jefferson
• Morgan Jeknavorian, RRT
• David Jenkins, M.D.
• Jami Jenkins, PHARMD,RPH

• Primary Care Clinic/Center in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Primary Care Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.