Active NPI
Carolyn Jackson, BSW
- Social Worker
- Baton Rouge, LA
National Provider Identifier
1821460742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 11616 Southfork Ave
Baton Rouge, LA 70816-5241 - Phone
- (225) 291-9646
- Fax
- (225) 291-9692
- NPI assigned
- Oct 30, 2015
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | LA | Primary |
Addresses
Primary practice location
11616 Southfork Ave
Baton Rouge, LA 70816-5241
Mailing address
40447 Millie Road
Hammond, LA 70403-0000
Phone (985) 215-9750
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 600751961 | Medicaid | LA |
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": "1446163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446163200000",
"number": "1821460742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40447 MILLIE ROAD",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704030000",
"telephone_number": "985-215-9750",
"fax_number": "225-291-9692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11616 SOUTHFORK AVE",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708165241",
"telephone_number": "225-291-9646",
"fax_number": "225-291-9692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CAROLYN",
"credential": "BSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-30",
"last_updated": "2015-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "LA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "600751961",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.