Active NPI
Leathrice Jack
- Home Modifications Contractor
- Ville Platte, LA
National Provider Identifier
1649606989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- 555855
- Practice address
- 709 East Jefferson St
Ville Platte, LA 70586 - Phone
- (337) 336-0341
- NPI assigned
- Sep 18, 2013
- Last updated
- Sep 18, 2013
- 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 |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 555855 | LA | Primary |
Addresses
Primary practice location
709 East Jefferson St
Ville Platte, LA 70586
Mailing address
709 E Jefferson St
Ville Platte, LA 70586-3911
Phone (337) 336-0341
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 555855 | LA | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379462400000",
"number": "1649606989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 E JEFFERSON ST",
"city": "VILLE PLATTE",
"state": "LA",
"postal_code": "705863911",
"telephone_number": "337-336-0341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 EAST JEFFERSON ST",
"city": "VILLE PLATTE",
"state": "LA",
"postal_code": "70586",
"telephone_number": "337-336-0341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "LEATHRICE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-18",
"last_updated": "2013-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "LA",
"license": "555855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ville Platte, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.