Active NPI
Justin Keith Jetton
- Peer Specialist
- Shreveport, LA
National Provider Identifier
1376306936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 1310 N Hearne Ave
Shreveport, LA 71107-6516 - Phone
- (318) 676-5111
- Fax
- (318) 676-5137
- NPI assigned
- Feb 5, 2024
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | LA | Primary |
Addresses
Primary practice location
1310 N Hearne Ave
Shreveport, LA 71107-6516
Mailing address
1310 N Hearne Ave
Shreveport, LA 71107-6516
Phone (318) 676-5111
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": "1707091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707264000000",
"number": "1376306936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 N HEARNE AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711076516",
"telephone_number": "318-676-5111",
"fax_number": "318-676-5137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 N HEARNE AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711076516",
"telephone_number": "318-676-5111",
"fax_number": "318-676-5137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JETTON",
"first_name": "JUSTIN",
"middle_name": "KEITH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-02-05",
"last_updated": "2024-02-07",
"certification_date": "2024-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "LA",
"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 Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.