Active NPI
Jacquelle Jackson
- Case Manager/Care Coordinator
- Shreveport, LA
National Provider Identifier
1316394141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 331 Milam St
Shreveport, LA 71101 - Phone
- (318) 213-0904
- NPI assigned
- May 23, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
331 Milam St
Shreveport, LA 71101
Mailing address
9730 Baird Rd Apt 2310
Shreveport, LA 71118-3879
Phone (318) 560-2311
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": "1463961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542672000000",
"number": "1316394141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9730 BAIRD RD APT 2310",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711183879",
"telephone_number": "318-560-2311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "331 MILAM ST",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "71101",
"telephone_number": "318-213-0904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JACQUELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-23",
"last_updated": "2018-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.