Active NPI
Jerry L Whiteman, PHD.
- Psychologist
- Lake Charles, LA
National Provider Identifier
1215996095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 407
- Practice address
- 2829 4TH Ave
150
Lake Charles, LA 70601-7887 - Phone
- (337) 477-7091
- Fax
- (337) 474-4552
- NPI assigned
- Mar 21, 2006
- Last updated
- Dec 2, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 407 | LA | Primary |
Addresses
Primary practice location
2829 4TH Ave
150
Lake Charles, LA 70601-7887
Mailing address
2829 4TH Ave
150
Lake Charles, LA 70601-7887
Phone (337) 477-7091
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1125466 | Medicaid | LA |
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 Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291248000000",
"number": "1215996095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2829 4TH AVE",
"address_2": "150",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706017887",
"telephone_number": "337-477-7091",
"fax_number": "337-474-4552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2829 4TH AVE",
"address_2": "150",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706017887",
"telephone_number": "337-477-7091",
"fax_number": "337-474-4552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITEMAN",
"first_name": "JERRY",
"middle_name": "L",
"credential": "PHD.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-21",
"last_updated": "2010-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "LA",
"license": "407",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1125466",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.