Angie Jerry, L-307666

Primary specialty

Lactation Consultant (Non-RN)Taxonomy code 174N00000X

License

L-307666 Issued in LA

Practice address

346 Brown Rd
Quitman, LA 71268-4717

Phone

(318) 614-8331

NPI assigned

Mar 12, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Angie Stevenson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1386402469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "346 BROWN RD",
            "city": "QUITMAN",
            "state": "LA",
            "postal_code": "712684717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "346 BROWN RD",
            "city": "QUITMAN",
            "state": "LA",
            "postal_code": "712684717",
            "telephone_number": "318-614-8331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERRY",
        "first_name": "ANGIE",
        "credential": "L-307666",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "LA",
            "license": "L-307666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGIE",
            "last_name": "STEVENSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Lactation Consultant (Non-RN) in Quitman, LA
• Providers in Quitman, LA by specialty
• Lactation Consultant (Non-RN) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.

Verify at the official NPI Registry.