Jacquelyn Dedral Nettles

Primary specialty

Attendant Care ProviderTaxonomy code 3747A0650X

Practice address

315 S College Rd Ste 252
Lafayette, LA 70503-3212

Phone

(337) 269-1169

Fax

(337) 235-1961

NPI assigned

Jun 9, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1427587609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 S COLLEGE RD STE 252",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033212",
            "telephone_number": "337-269-1169",
            "fax_number": "337-235-1961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 S COLLEGE RD STE 252",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033212",
            "telephone_number": "337-269-1169",
            "fax_number": "337-235-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "JACQUELYN",
        "middle_name": "DEDRAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-09",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Attendant Care Provider in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Attendant Care Provider in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.