Active NPI
Gwenn V Jackson, M.D.
- Obstetrics & Gynecology Physician
- West Monroe, LA
National Provider Identifier
1578560850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 16703
- Practice address
- 417 McMillan Rd
West Monroe, LA 71291-5325 - Phone
- (318) 322-7119
- Fax
- (318) 325-8475
- NPI assigned
- Jul 1, 2005
- Last updated
- Jan 14, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 16703 | LA | Primary |
Addresses
Primary practice location
417 McMillan Rd
West Monroe, LA 71291-5325
Mailing address
312 Grammont St
Ste 300
Monroe, LA 71201-7403
Phone (318) 388-4030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16703 | LA | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642118400000",
"number": "1578560850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 GRAMMONT ST",
"address_2": "STE 300",
"city": "MONROE",
"state": "LA",
"postal_code": "712017403",
"telephone_number": "318-388-4030",
"fax_number": "318-324-3334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 MCMILLAN RD",
"city": "WEST MONROE",
"state": "LA",
"postal_code": "712915325",
"telephone_number": "318-322-7119",
"fax_number": "318-325-8475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "GWENN",
"middle_name": "V",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-01",
"last_updated": "2022-01-14",
"certification_date": "2022-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "LA",
"license": "16703",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.