MMG Nelson Rd LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MMG NELSON RD LLC

Practice address

4345 Nelson Rd Ste 102
Lake Charles, LA 70605-4183

Phone

(337) 480-7900

Fax

(337) 602-6358

NPI assigned

Sep 11, 2015

Last updated

Dec 4, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

MEMORIAL MEDICAL GROUPAs reported in NPPES

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

Authorized official

Name

Dawn Johnson-Hatcher

Title

Cfo

Phone

(337) 494-2094

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Memorial Medical Group LLC

Interoperability endpoints

• Direct secure messaging: williamnabours@ppcllc.allscriptsdirect.net

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Memorial Medical Group, LLC

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1750846663
  NPPES parent name

Practitioners 24

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.

• Kendra B. Meche, NP

  • Adult Health Nurse Practitioner
  • Lake Charles, LA
  • NPI 1326295239
  Medicare reassignment Care Compare group NPD
• Logan Michael Soileau, DO

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1245811777
  Medicare reassignment Care Compare group NPD
• Jennifer Trombatore, FNP

  • Family Nurse Practitioner
  • Lake Charles, LA
  • NPI 1346893732
  Medicare reassignment Care Compare group NPD
• Joshua Allan Whatley, MD

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1386961787
  Medicare reassignment Care Compare group NPD
• Christian Jon Leblanc, MD

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1689115966
  Medicare reassignment Care Compare group
• Joshua Benjamin Bacon, MD

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1396274551
  Medicare reassignment NPD
• William Carl Nabours, MD

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1659371193
  Medicare reassignment NPD
• Robert Joseph Van Gossen Jr., MD

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1437546595
  Medicare reassignment NPD
• Carlee Theriot Carroll, APRN, FNP-C

  • Family Nurse Practitioner
  • Lake Charles, LA
  • NPI 1710527650
  NPD (past)
• Nathan Phillip Cohen, M.D.

  • Orthopaedic Surgery Physician
  • Lake Charles, LA
  • NPI 1285686774
  NPD (past)
• Kipp Cryar, MD

  • Orthopaedic Surgery Physician
  • Lake Charles, LA
  • NPI 1982023727
  NPD (past)
• Barry J Henry, M.D.

  • Orthopaedic Surgery Physician
  • Lake Charles, LA
  • NPI 1780681734
  NPD (past)

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1295103844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123594 DEPT 3594",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753123594",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4345 NELSON RD STE 102",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054183",
            "telephone_number": "337-480-7900",
            "fax_number": "337-602-6358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMG NELSON RD LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL MEDICAL GROUP",
        "enumeration_date": "2015-09-11",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-HATCHER",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-494-2094"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy Mitchell, M.D.
• William Alfred Mixon, M.D.
• Maura Carmouche Mize, M.A. CCC-SLP
• ML Williams LLC
• MMG Archer Institute, LLC (MMG Archer Institute)
• Mobile Imaging, Inc.
• Mobile Imaging, Inc.
• Mobility Plus Medical Supply
• Mobility Plus Medical Supply LLC
• Kevin E Mocklin, M.D.

• General Practice Physician in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• General Practice Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.