Active NPI
Kellie Mandygo
- Community Health Worker
- Shreveport, LA
National Provider Identifier
1720520752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 3341 Youree Dr
Shreveport, LA 71105-2149 - Phone
- (318) 219-4167
- Fax
- (318) 219-4834
- NPI assigned
- Nov 8, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
3341 Youree Dr
Shreveport, LA 71105-2149
Mailing address
3341 Youree Dr
Shreveport, LA 71105-2149
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563926400000",
"number": "1720520752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3341 YOUREE DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711052149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3341 YOUREE DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711052149",
"telephone_number": "318-219-4167",
"fax_number": "318-219-4834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDYGO",
"first_name": "KELLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-08",
"last_updated": "2019-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.