Individual provider Active NPI

Tracy Minchew Jordan, FNP

  • Nurse Practitioner
  • Winnsboro, LA
National Provider Identifier
1487926671
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APO6744 Issued in LA
Practice address
2104 Loop Rd
Suite C
Winnsboro, LA 71295-3338
Phone
(318) 435-4571
Fax
(318) 435-7458
NPI assigned
Feb 2, 2012
Last updated
Feb 2, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APO6744 LA Primary

Addresses

Primary practice location

2104 Loop Rd
Suite C
Winnsboro, LA 71295-3338

Mailing address

2104 Loop Rd
Suite C
Winnsboro, LA 71295-3338
Phone (318) 435-4571

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
I20120319000088 LA Practitioner - Nurse Practitioner 3779742341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1205 Hwy 15
Baskin, LA 71219-9698
Phone (318) 248-2249

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APO6744LAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sisters Medical Clinic LLC CurrentSince Apr 13, 2017 Accepting new patients

Locations

1205 Highway 15
Baskin, LA 71219
Phone (318) 248-2249

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1328140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1487926671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 LOOP RD",
            "address_2": "SUITE C",
            "city": "WINNSBORO",
            "state": "LA",
            "postal_code": "712953338",
            "telephone_number": "318-435-4571",
            "fax_number": "318-435-7458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 LOOP RD",
            "address_2": "SUITE C",
            "city": "WINNSBORO",
            "state": "LA",
            "postal_code": "712953338",
            "telephone_number": "318-435-4571",
            "fax_number": "318-435-7458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "TRACY",
        "middle_name": "MINCHEW",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-02",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "APO6744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winnsboro, LA

Sources for this page

Verify at the official NPI Registry.