Individual provider Active NPI

Susannah Holt

  • Family Nurse Practitioner
  • Mansfield, LA
National Provider Identifier
1801624093
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
208255 Issued in LA
Practice address
1121 Polk St
Mansfield, LA 71052-2524
Phone
(318) 575-2143
NPI assigned
Jul 22, 2024
Last updated
Jul 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 208255 LA Primary

Addresses

Primary practice location

1121 Polk St
Mansfield, LA 71052-2524

Mailing address

PO Box 306416
Nashville, TN 37230-6416

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240917002470 LA Practitioner - Nurse Practitioner 1759822893 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Calcasieu Urgent Care LLCGroup PAC ID 5496908071, 132 clinicians

Practice addresses (Care Compare)

1121 Polk St
Mansfield, LA 71052-2524
Phone (318) 575-2143

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
208255LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Calcasieu Urgent Care, LLC CurrentSince Jul 20, 2024 Accepting new patients
Upperline Healthcare, PC CurrentSince Sep 1, 2025 Accepting new patients
Calcasieu Urgent Care LLC CurrentSince Jul 20, 2024 Accepting new patients
Upperline Healthcare, PC CurrentSince Sep 1, 2025 Accepting new patients

Locations

280A Rees St
Breaux Bridge, LA 70517
Phone (337) 294-0701

213 W Veterans Meml Dr
Kaplan, LA 70548
Phone (337) 282-1096

2640 Country Club Rd
Ste 400
Lake Charles, LA 70605
Phone (337) 426-0919

1121 Polk St
Mansfield, LA 71052
Phone (318) 575-2143

132 Well Rd
West Monroe, LA 71291
Phone (318) 217-6521

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1801624093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306416",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 POLK ST",
            "city": "MANSFIELD",
            "state": "LA",
            "postal_code": "710522524",
            "telephone_number": "318-575-2143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLT",
        "first_name": "SUSANNAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "208255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, LA

Sources for this page

Verify at the official NPI Registry.