Oakdale Childrens Clinic

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

OAKDALE CHILDRENS CLINIC

Practice address

211 N 16TH St
Oakdale, LA 71463-2211

Phone

(318) 817-1064

Fax

(318) 817-1065

NPI assigned

Aug 11, 2023

Organization subpart

No

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

Authorized official

Name

Melinda Baker

Title

Office Administrator

Phone

(318) 481-3077

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Rural health clinic certification: CCN 198921

Legal name

OAKDALE CHILDRENS CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Feb 1, 2024

Last certification

Feb 1, 2024

Ownership / control type

1A

Organization structure

LLCProprietary

Incorporated

Aug 8, 2023 in LA

Enrollment address

211 N 16TH St
Alexandria, LA 71463-2211

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anil S.a. Danivas

  • Pediatrics Physician
  • Alexandria, LA
  • NPI 1740283852
  NPD
• Maira Martinez, RLT

  • Behavior Technician
  • Shreveport, LA
  • NPI 1376220848
  NPD
• Laura Elizabeth Williamson, APRN

  • Pediatric Nurse Practitioner
  • Alexandria, LA
  • NPI 1033679501
  NPD (past)
• Jessica Floyd Thibodeaux, APRN

  • Critical Care Pediatric Nurse Practitioner
  • Flagstaff, AZ
  • NPI 1588189567
  NPD (past)

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

{
    "created_epoch": "1691712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1467135756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N 16TH ST",
            "city": "OAKDALE",
            "state": "LA",
            "postal_code": "714632211",
            "telephone_number": "318-817-1064",
            "fax_number": "318-817-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 N 16TH ST",
            "city": "OAKDALE",
            "state": "LA",
            "postal_code": "714632211",
            "telephone_number": "318-817-1064",
            "fax_number": "318-817-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKDALE CHILDRENS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-11",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "318-481-3077"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Namaste Massage & Therapeutics, Inc.
• Nes Central Louisiana, Inc.
• Nesom Family Clinic
• Herbert Aldon Nesom Jr., M.D.
• Tamatha P. Newman, FNP
• Oakdale Chiropractic Clinic
• Oakdale Drug Co Inc
• Oakdale Ess LLC
• Oakdale Internal Medicine
• Jeri Ann Odom, RPH

• Rural Health Clinic/Center in Oakdale, LA
• Providers in Oakdale, LA by specialty
• Rural Health Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.