Active NPI
Jacqueline Lynn Jackson, PROVIDE CARE
- In Home Supportive Care Agency
- Shreveport, LA
National Provider Identifier
1750895926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- In Home Supportive Care Agency
- License
- 00294507
- Practice address
- 1842 Murphy St
Shreveport, LA 71103-2919 - Phone
- (318) 834-8136
- NPI assigned
- Nov 27, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| In Home Supportive Care Agency | 253Z00000X | 00294507 | LA | Primary |
Addresses
Primary practice location
1842 Murphy St
Shreveport, LA 71103-2919
Mailing address
1842 Murphy St
Shreveport, LA 71103-2919
Phone (318) 834-8136
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 |
|---|---|---|---|
| 00294507 | LA | MD | In Home Supportive Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511740800000",
"number": "1750895926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1842 MURPHY ST",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711032919",
"telephone_number": "318-834-8136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1842 MURPHY ST",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711032919",
"telephone_number": "318-834-8136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JACQUELINE",
"middle_name": "LYNN",
"name_prefix": "Miss",
"credential": "PROVIDE CARE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-27",
"last_updated": "2017-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": "LA",
"license": "00294507",
"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 Nov 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.