Andrew Jackson III

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1401 Hudson LN
Suite 202
Monroe, LA 71201-6068

Phone

(318) 570-5400

NPI assigned

Nov 30, 2016

Last updated

Jan 7, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1480464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1508309055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 HUDSON LN",
            "address_2": "SUITE 202",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712016068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 HUDSON LN",
            "address_2": "SUITE 202",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712016068",
            "telephone_number": "318-570-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANDREW",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-30",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "1306217062",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J Dean Stockstill MD, a Professional Medical Corporation
• J Eric Lavespere DDS LLC
• J. Scott Caldwell, D. C., a Professional Chiropractic Corporation (Doctor's Center)
• Ned Michael Jabour Sr., PH.D., LPC
• Jackson Home Health
• Beverly Jackson
• Brianna Mo'Nique Jackson
• Chellcy Jackson, MS
• Felica Jackson
• Ida Jackson

• Case Manager/Care Coordinator in Monroe, LA
• Providers in Monroe, LA by specialty
• Case Manager/Care Coordinator in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.

Verify at the official NPI Registry.