Pelican Pediatrics, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

2203781980 Issued in LA

Legal business name

PELICAN PEDIATRICS, LLC

Practice address

911 W Main St
Suite C
Homer, LA 71040-3300

Phone

(318) 927-3255

Fax

(318) 927-3257

NPI assigned

Nov 7, 2013

Last updated

Oct 1, 2014By 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

Mrs. Leslie Couvillon Brasher, APRN, CPNPNPI 1629231535

Title

Owner, Manager

Phone

(318) 927-3255

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184053340. Details of each certification follow.

• CCN 193912 Rural health clinic · Active · Details

Rural health clinic certification: CCN 193912

Legal name

PELICAN PEDIATRICS LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jun 10, 2014

Last certification

Jun 26, 2025

Ownership / control type

1A

Organization structure

OtherProprietary

Enrollment address

740 W Main St
Homer, LA 71040-3315

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Melinda Willis, MD

  • Pediatrics Physician
  • Arcadia, LA
  • NPI 1427113588

  Corporate Director

  CMS ownership

Practitioners 2

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.

• Leslie C Brasher, C.P.N.P.

  • Pediatric Nurse Practitioner
  • Homer, LA
  • NPI 1629231535

  Pediatrics

  NPD Authorized official
• Barbara Anne Hutches, MA, LMFT, ATR

  • Marriage & Family Therapist
  • Shreveport, LA
  • NPI 1437627841
  NPD (past)

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1184053340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 W MAIN ST",
            "address_2": "SUITE C",
            "city": "HOMER",
            "state": "LA",
            "postal_code": "710403300",
            "telephone_number": "318-927-3255",
            "fax_number": "318-927-3257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 W MAIN ST",
            "address_2": "SUITE C",
            "city": "HOMER",
            "state": "LA",
            "postal_code": "710403300",
            "telephone_number": "318-927-3255",
            "fax_number": "318-927-3257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELICAN PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-07",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "BRASHER",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "COUVILLON",
        "authorized_official_title_or_position": "OWNER, MANAGER",
        "authorized_official_telephone_number": "318-927-3255",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN, CPNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "2203781980",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "LA",
            "license": "APO5536",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1325295",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Norton Family Dentistry,LLC
• Georgia Norton
• Jariel Eugene Norton
• James Carlton Palmer, D.D.S.
• Pave Center, Inc.
• Presbyterian Village of Homer
• Melvin Harold Procell, DDS
• Katherine Rains, ACNP
• Margie Randall, LPN
• Kimberly Holley Reagan, MD

• Rural Health Clinic/Center in Homer, LA
• Providers in Homer, LA by specialty
• Rural Health Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.