Individual provider Active NPI

Ellisa Gladney

  • Case Manager/Care Coordinator
  • Bossier City, LA
National Provider Identifier
1356893887
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
1609 Hill St
Bossier City, LA 71111-4121
Phone
(318) 505-1114
NPI assigned
Nov 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LA
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

1609 Hill St
Bossier City, LA 71111-4121

Mailing address

610 Stockbridge LN
Shreveport, LA 71107-1951
Phone (318) 393-3451

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": "1477958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1356893887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 STOCKBRIDGE LN",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711071951",
            "telephone_number": "318-393-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 HILL ST",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711114121",
            "telephone_number": "318-505-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLADNEY",
        "first_name": "ELLISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-01",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.