Active NPI
Shaunice Wilson
- Case Manager/Care Coordinator
- Rodessa, LA
National Provider Identifier
1417315474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 17702 Rodessa Church Rd
Rodessa, LA 71069-9034 - Phone
- (903) 244-0622
- NPI assigned
- Feb 5, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
17702 Rodessa Church Rd
Rodessa, LA 71069-9034
Mailing address
P.O. Box 5
Rodessa, LA 71069
Phone (903) 244-0622
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| XUQ201937155 | Other | LA | BLUE CROSS AND BLUE SHIELD LOUISIANA |
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": "1454630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548201600000",
"number": "1417315474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 5",
"city": "RODESSA",
"state": "LA",
"postal_code": "71069",
"telephone_number": "903-244-0622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17702 RODESSA CHURCH RD",
"city": "RODESSA",
"state": "LA",
"postal_code": "710699034",
"telephone_number": "903-244-0622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SHAUNICE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-05",
"last_updated": "2019-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIELD LOUISIANA",
"identifier": "XUQ201937155",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rodessa, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.