Individual provider Active NPI

Mikki Andrea Royston, NP

  • Family Nurse Practitioner
  • Broussard, LA
National Provider Identifier
1184356511
Registry record updated Nov 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
226384 Issued in LA
Practice address
109 Saint Nazaire Rd Ste C
Broussard, LA 70518-4257
Phone
(337) 470-4700
Fax
(337) 470-4716
NPI assigned
Jun 24, 2022
Last updated
Nov 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 226384 LA Primary

Addresses

Primary practice location

109 Saint Nazaire Rd Ste C
Broussard, LA 70518-4257

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (337) 470-4700

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mroyston74256@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

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
I20220829003614 LA Practitioner - Nurse Practitioner 0244614915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lourdes Physician Group LLCGroup PAC ID 7214177757, 157 clinicians

Practice addresses (Care Compare)

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508-6917
Phone (337) 470-2990

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
226384LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lourdes Physician Group LLC Nurse Practitioner CurrentSince Aug 14, 2022 Accepting new patients

Locations

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

109 Saint Nazaire Rd
Ste C
Broussard, LA 70518
Phone (337) 470-4700

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508
Phone (337) 470-2000

Interoperability endpoints

  • Direct secure messaging: mroyston74256@direct.casso.us.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1656028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1184356511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "337-470-4700",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 SAINT NAZAIRE RD STE C",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705184257",
            "telephone_number": "337-470-4700",
            "fax_number": "337-470-4716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROYSTON",
        "first_name": "MIKKI",
        "middle_name": "ANDREA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-24",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "226384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mroyston74256@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mroyston74256@direct.casso.us.com",
            "address_1": "109 Saint Nazaire Rd Ste C",
            "city": "Broussard",
            "state": "LA",
            "country_code": "US",
            "postal_code": "705184257",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "109 Saint Nazaire Rd Ste C",
            "city": "Broussard",
            "state": "LA",
            "country_code": "US",
            "postal_code": "705184257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Broussard, LA

Sources for this page

Verify at the official NPI Registry.