Jenita Blue

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15403 Issued in LA

Practice address

1000 Chinaberry Dr Ste 900
Bossier City, LA 71111-2455

Phone

(318) 459-6579

NPI assigned

Jun 24, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• David Raines Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
  • NPI 1215933254
  Medicare reassignment NPD
• Foundation Counseling, Coaching & Consultations

  • Clinical Social Worker
  • Shreveport, LA
  • NPI 1336019611
  NPD Authorized official
• David Raines Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
  • NPI 1205721487
  NPD
• David Raines Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
  • NPI 1760906630
  NPD

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1780245498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4830 LINE AVE # 5764",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711061530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CHINABERRY DR STE 900",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112455",
            "telephone_number": "318-459-6579"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3341 Youree Dr",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711052149",
            "country_code": "US",
            "telephone_number": "318-219-4167",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1533 Marshall St",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711013941",
            "country_code": "US",
            "telephone_number": "318-626-5597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLUE",
        "first_name": "JENITA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-24",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "LA",
            "license": "15403",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "15403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristopher Brent Blaylock, RPH
• Jaime Blazier
• Marjorie Blochousse, MD
• Earl Bloomer
• Alice C Blue, APRN
• Abigail Davis Bogan, PA-C
• Peter Bryan Boggs, M.D.
• Shamarie Bolden
• Jackie Boling, LCSW
• William A. Bolinger, D.D.S.

• Clinical Social Worker in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Clinical Social Worker in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.