Pine Prairie Family Healthcare, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PINE PRAIRIE FAMILY HEALTHCARE, LLC

Practice address

1015 Sanders Street
Pine Prairie, LA 70576-3611

Phone

(337) 599-2850

Fax

(337) 599-2852

NPI assigned

Mar 17, 2014

Organization subpart

No

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

Authorized official

Name

Nicole DoucetNPI 1174520035

Title

FNP

Phone

(337) 779-6000

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 193927

Legal name

PINE PRAIRIE FAMILY HEALTHCARE LLC

Doing business as

PINE PRAIRIE FAMILY HEALTH CARE

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 11, 2017

Last certification

Aug 11, 2023

Ownership / control type

1B

Organization structure

LLCProprietary

Incorporated

Mar 1, 2014 in LA

Enrollment address

1015 Sanders Street
Pine Prairie, LA 70576-3001

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.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Nicole H Doucet, NP

  • Family Nurse Practitioner
  • Iota, LA
  • NPI 1174520035

  Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Practitioners 3

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

• Nicole H Doucet, NP

  • Family Nurse Practitioner
  • Iota, LA
  • NPI 1174520035
  Medicare reassignment Care Compare group Authorized official
• Lisa Renee Brown, FNP

  • Family Nurse Practitioner
  • Pine Prairie, LA
  • NPI 1053777862
  Medicare reassignment Care Compare group NPD
• Chelsea Faith Paul, FNP-C

  • Family Nurse Practitioner
  • Pine Prairie, LA
  • NPI 1023818077
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1588080386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 SANDERS STREET",
            "address_2": "PO BOX 736",
            "city": "PINE PRAIRIE",
            "state": "LA",
            "postal_code": "705763611",
            "telephone_number": "337-599-2850",
            "fax_number": "337-599-2852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 SANDERS STREET",
            "city": "PINE PRAIRIE",
            "state": "LA",
            "postal_code": "705763611",
            "telephone_number": "337-599-2850",
            "fax_number": "337-599-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE PRAIRIE FAMILY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-17",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "DOUCET",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "FNP",
        "authorized_official_telephone_number": "337-779-6000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "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": []
}

• Lisa Renee Brown, FNP
• Betty Ventress Jordan, N.P.
• Kaitlyn Spears OT LLC
• Nick-Nard Inc (Fuselier's Pharmacy)
• Chelsea Faith Paul, FNP-C
• Pine Prairie Pharmacy,Inc
• Play With Purpose Pediatric Therapy, LLC
• Prairie Manor, Inc. (Prairie Manor Nursing Home)
• Carmen Nicole Rollins, FNP
• Savoy Medical Management Group, Inc. (Pine Prairie Community Clinic)

• Rural Health Clinic/Center in Pine Prairie, LA
• Providers in Pine Prairie, 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 Mar 11, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.