Active NPI
Jermine Theresa Prater
- Case Manager/Care Coordinator
- Mansura, LA
National Provider Identifier
1235650417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 2104 Cleco Street
Mansura, LA 71350 - Phone
- (318) 964-2679
- Fax
- (318) 964-2683
- NPI assigned
- Jun 28, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | LA | ||
| Counselor | 101Y00000X | |||
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
2104 Cleco Street
Mansura, LA 71350
Mailing address
Post Office Box 450
Mansura, LA 71350
Phone (318) 964-2679
Other practice location 1
1140 Shirley Rd
Bunkie, LA 71322-1545
Phone (318) 346-8001
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679507412 | Other | LA | NPI |
| 1544761 | Medicaid | LA | |
| 721422495 | Other | LA | TAX IDENTIFICATION |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686873600000",
"number": "1235650417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "POST OFFICE BOX 450",
"city": "MANSURA",
"state": "LA",
"postal_code": "71350",
"telephone_number": "318-964-2679",
"fax_number": "318-964-2683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2104 CLECO STREET",
"city": "MANSURA",
"state": "LA",
"postal_code": "71350",
"telephone_number": "318-964-2679",
"fax_number": "318-964-2683"
}
],
"practiceLocations": [
{
"address_1": "1140 Shirley Rd",
"address_purpose": "LOCATION",
"city": "Bunkie",
"state": "LA",
"postal_code": "713221545",
"country_code": "US",
"telephone_number": "318-346-8001",
"fax_number": "318-346-8005",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PRATER",
"first_name": "JERMINE",
"middle_name": "THERESA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-28",
"last_updated": "2023-06-16",
"certification_date": "2023-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": "LA",
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1679507412",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1544761",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTIFICATION",
"identifier": "721422495",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mansura, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.