Individual provider Active NPI

Katrina Gipson

  • Gerontology Nurse Practitioner
  • Monroe, LA
National Provider Identifier
1366008500
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
207621 Issued in LA
Practice address
4864 Jackson St
Monroe, LA 71202-6400
Phone
(318) 330-7000
NPI assigned
May 14, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 207621 LA
Gerontology Nurse Practitioner 363LG0600X 207621 LA Primary

Addresses

Primary practice location

4864 Jackson St
Monroe, LA 71202-6400

Mailing address

1512 W Kirby PL
Shreveport, LA 71103-3822
Phone (318) 626-0287

Other practice location 1

920 Oliver Rd
Monroe, LA 71201-5702
Phone (318) 807-6267

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190911003497 LA Practitioner - Nurse Practitioner 9739441973 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4864 Jackson St
Monroe, LA 71202-6400
Phone (318) 330-7167

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
207621LAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Health Group, LLC CurrentSince Sep 3, 2019 Accepting new patients
Lsu Health Sciences Center Shreveport Faculty Group Practice CurrentSince Jun 27, 2022 Accepting new patients
Affinity Health Group, LLC CurrentSince Sep 3, 2019 Accepting new patients
Fresenius Medical Care Monroe, LLC PastSince Feb 28, 2016 Accepting new patients

Locations

261 Highway 132
Mangham, LA 71259
Phone (318) 248-2807

2408 Broadmoor Blvd
Monroe, LA 71201
Phone (318) 410-0002

4864 Jackson St
Monroe, LA 71202
Phone (318) 330-7000

920 Oliver Rd
Monroe, LA 71201
Phone (318) 807-6267

2408 Broadmoor Blvd
Ste 2
Monroe, LA 71201
Phone (318) 807-0525

130 Desiard St
Ste 355
Monroe, LA 71201
Phone (318) 807-7875

1512 W Kirby Pl
Shreveport, LA 71103
Phone (318) 626-0177

1541 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0287

1606 Kings Hwy
Shreveport, LA 71103
Phone (318) 675-6402

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1366008500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 W KIRBY PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033822",
            "telephone_number": "318-626-0287",
            "fax_number": "318-629-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4864 JACKSON ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026400",
            "telephone_number": "318-330-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 Oliver Rd",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712015702",
            "country_code": "US",
            "telephone_number": "318-807-6267",
            "fax_number": "318-812-6458",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIPSON",
        "first_name": "KATRINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-14",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "207621",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "LA",
            "license": "207621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

Verify at the official NPI Registry.