Jackson Street Pediatrics, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

JACKSON STREET PEDIATRICS, LLC

Practice address

5716 Jackson St
Alexandria, LA 71303-2042

Phone

(318) 767-6503

Fax

(318) 703-8257

NPI assigned

Jul 10, 2020

Last updated

Jul 10, 2020By 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

Kai A Wicker-Brown, MDNPI 1457569063

Title

Owner

Phone

(313) 300-3637

Specialties & licenses 1

Addresses

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

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.

• Kai Alexandria Wicker Brown, MD

  • Pediatrics Physician
  • Alexandria, LA
  • NPI 1457569063
  NPD Authorized official

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

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594339200000",
    "number": "1205454774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6326 WINDY OAKS",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713012966",
            "telephone_number": "313-300-3637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5716 JACKSON ST",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713032042",
            "telephone_number": "318-767-6503",
            "fax_number": "318-703-8257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON STREET PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-10",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A",
        "authorized_official_last_name": "WICKER-BROWN",
        "authorized_official_first_name": "KAI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-300-3637",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Ivory
• Molly McKay Ivy
• J a Badeaux III MD a Professional Medical Corporation
• Jackson Group Home
• Jackson Street Medical Center
• Ashley Jackson, LPN
• Brittney Baylor Jackson, CNA
• Falon Jackson
• Jamerson E. Jackson
• Jarrod Jerome Jackson

• Pediatrics Physician in Alexandria, LA
• Providers in Alexandria, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.