Individual provider Active NPI

Nicole McKenna, NP

  • Acute Care Nurse Practitioner
  • Baton Rouge, LA
National Provider Identifier
1447039722
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
232394 Issued in LA
Practice address
7777 Hennessy Blvd Ste 409
Baton Rouge, LA 70808-4365
Phone
(225) 765-5864
NPI assigned
Sep 26, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 232394 LA Primary

Addresses

Primary practice location

7777 Hennessy Blvd Ste 409
Baton Rouge, LA 70808-4365

Mailing address

7777 Hennessy Blvd Ste 409
Baton Rouge, LA 70808-4365
Phone (225) 765-5864

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
I20240221001462 LA Practitioner - Nurse Practitioner 8022452770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Practice addresses (Care Compare)

7777 Hennessy Blvd
Suite 409
Baton Rouge, LA 70808-4365
Phone (225) 765-5864

Hospital & facility affiliations

  • Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
232394LAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group LLC Nurse Practitioner CurrentSince Jan 9, 2024 Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Jan 9, 2024 Accepting new patients

Locations

7777 Hennessy Blvd
Ste 409
Baton Rouge, LA 70808
Phone (225) 765-1765

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

Interoperability endpoints

  • Direct secure messaging: nmckenna82985@direct.casso.us.com

Organizations & group practices 2

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 1

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": "1695686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1447039722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD STE 409",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084365",
            "telephone_number": "225-765-5864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD STE 409",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084365",
            "telephone_number": "225-765-5864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-26",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "LA",
            "license": "232394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.