Active NPI
Austin Jacquillard
- Licensed Vocational Nurse
- Clearlake, CA
National Provider Identifier
1669287835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 337535
- Practice address
- 15145 Lakeshore Dr
Clearlake, CA 95422-8106 - Phone
- (707) 995-7200
- NPI assigned
- Feb 12, 2025
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 337535 | TX | Primary |
Addresses
Primary practice location
15145 Lakeshore Dr
Clearlake, CA 95422-8106
Mailing address
98-703 Iho PL
BLDG 1 Apt 703
Aiea, HI 96701
Phone (559) 367-8213
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 |
|---|---|---|---|
| 337535 | TX | MD | Licensed Vocational Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Lake | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Lake County Behavioral Health Services
- Community/Behavioral Health Agency
- Lucerne, CA
- NPI 1215140066
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739318400000",
"number": "1669287835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98-703 IHO PL",
"address_2": "BLDG 1 APT 703",
"city": "AIEA",
"state": "HI",
"postal_code": "96701",
"telephone_number": "559-367-8213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15145 LAKESHORE DR",
"city": "CLEARLAKE",
"state": "CA",
"postal_code": "954228106",
"telephone_number": "707-995-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACQUILLARD",
"first_name": "AUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-02-12",
"last_updated": "2025-02-12",
"certification_date": "2025-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "TX",
"license": "337535",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearlake, CA
- Huong Thu Huynh
- Ilkyoon Kim MD a Prof Corp (same)
- James William Isherwood III, LCSW
- Jack M. Elizares Optometric Corporation
- Claire Elise Jacobs
- Jennifer a Dowalter MD a Professional Corporation
- Raymond Dean Jennings, MD
- Jeong Sik Park MD a Prof Corp
- JJ&R Emergency Medical Group of California, Inc.
- Candieda Lee-Denise Johnson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.