Individual provider Active NPI

Jessica R Le Noue, DO

  • General Practice Physician
  • Pensacola, FL
National Provider Identifier
1174051676
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
5101024408 Issued in MI
Practice address
760 East Ave
Pensacola, FL 32508-5136
Phone
(850) 452-8970
NPI assigned
May 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 5101024408 MI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

760 East Ave
Pensacola, FL 32508-5136

Mailing address

113 Lielmanis Ave
Hurlburt Field, FL 32544-5613
Phone (850) 881-1020

Other practice location 1

113 Lielmanis Ave
Hurlburt Field, FL 32544-5613
Phone (850) 881-1020

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
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101024408MIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Branch Medical Clinic Nattc PastSince Apr 14, 2024 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1495843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1174051676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 LIELMANIS AVE",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "325445613",
            "telephone_number": "850-881-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 EAST AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325085136",
            "telephone_number": "850-452-8970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "113 Lielmanis Ave",
            "address_purpose": "LOCATION",
            "city": "Hurlburt Field",
            "state": "FL",
            "postal_code": "325445613",
            "country_code": "US",
            "telephone_number": "850-881-1020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LE NOUE",
        "first_name": "JESSICA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-27",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "5101024408",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.