Alice J Fanning, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

TAP002540 Issued in LA

Practice address

926 Frances Dr
Haynesville, LA 71038-6100

Phone

(318) 624-0554

Fax

(318) 624-3782

NPI assigned

Jun 2, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA, AR2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  AR

  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  LA

  Medicare reassignment NPD

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306972800000",
    "number": "1235423658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 FRANCES DR",
            "city": "HAYNESVILLE",
            "state": "LA",
            "postal_code": "710386100",
            "telephone_number": "318-624-0554",
            "fax_number": "318-624-3782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "926 FRANCES DR",
            "city": "HAYNESVILLE",
            "state": "LA",
            "postal_code": "710386100",
            "telephone_number": "318-624-0554",
            "fax_number": "318-624-3782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNING",
        "first_name": "ALICE",
        "middle_name": "J",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-02",
        "last_updated": "2011-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "TAP002540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Butler-Abshire Medical Clinic, Apmc
• Clint Chachere Butler, MD
• Crossroads Rehabilitation
• Crossroads Rehabilitation, LLC
• David Raines Community Health Center, Inc
• Paula Herrington
• Homer Memorial Hospital (Butler-Abshire Medical Clinic)
• James K Killgore Inc (Killgores Pharmacy)
• Kilgore Pharmacy LLC
• Kilgore Pharmacy LLC (Killgore Pharmacy)

• Family Nurse Practitioner in Haynesville, LA
• Providers in Haynesville, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.