Jessica Lynn Landry, NURSE PRACTITIONER
Individual provider Active NPI Nurse Practitioner · Lafayette, LA
NPI 1508975111 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508975111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- RN100751 (LA)
- Practice address
- 2390 W Congress Street
University Med Center
Lafayette, LA 70596 - Phone
- (337) 261-6000
- NPI assigned
- Aug 29, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050415000756 | LA | Practitioner - Nurse Practitioner | 0941259527 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN100751 | LA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Emergency Medicine Management -- Lake Charles LLC | Current |
Accepting new patients | |
| St Tammany Emergency Physicians Group LLC | Current |
Accepting new patients | |
| Washington Parish Emergency Physicians Group LLC | Current |
Accepting new patients | |
| Acadiana Concern for AIDS Relief Education and Support, Inc. | Current |
Accepting new patients | |
| Acadiana Concern for AIDS Relief Education and Support, Inc. | Past | Accepting new patients | |
| Minute Med Clinic LLC | Past |
Accepting new patients |
Locations
433 Plaza St
Bogalusa, LA 70427
Phone (985) 730-6700
1202 S Tyler St
Covington, LA 70433
Phone (985) 898-3743
809 Mlk Dr
Lafayette, LA 70501
Phone (337) 233-2437
1701 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-3000
Interoperability endpoints
- jessica@acadianacares.ssdirect.aprima.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN100751 | LA | Yes |
Addresses
Primary practice location
2390 W Congress Street
University Med Center
Lafayette, LA 70596
Mailing address
112 Summertyme Drive
Youngsville, LA 70592
Phone (337) 856-0973
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1478890 | Medicaid | LA |
Other providers in Lafayette, LA
- Jacob Edward Landry
- James Landry
- Jason Alton Landry
- Jason D. Landry
- Jennifer Landry
- Jody Lynn Landry
- Johanna Ball Fruge Landry
- Joslyn R Landry
- Katelyn H Landry
- Kelcie Landry
All providers in Lafayette, LA · Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.