Kristen Bordelon Jeansonne, NURSE PRACTITIONER
Individual provider Active NPI Family Nurse Practitioner · Cottonport, LA
NPI 1831612415 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1831612415
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP09522 (LA)
- Practice address
- 1007 Sycamore St Ste B
Cottonport, LA 71327-3403 - Phone
- (800) 462-0742
- Fax
- (318) 964-2554
- NPI assigned
- Jul 25, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170905000943 | LA | Practitioner - Nurse Practitioner | 8921371477 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP09522 | LA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cenla Family Medicine Associates, LLC | Nurse Practitioner | Current |
Accepting new patients |
| Winn Community Health Center, Inc. | Current |
Accepting new patients | |
| Winn Community Health Center, Inc. | Current | Accepting new patients | |
| Winn Community Health Center, Inc. | Current |
Accepting new patients | |
| Winn Community Health Center, Inc. | Family | Past | Accepting new patients |
| Winn Community Health Center, Inc. | Past | Accepting new patients | |
| Winn Community Health Center, Inc. | Past | Accepting new patients | |
| Winn Community Health Center, Inc. | Family | Past | Accepting new patients |
| Winn Community Health Center, Inc. | Past | Accepting new patients |
Locations (25 of 38)
4203 Lisa St
Alexandria, LA 71302
Phone (318) 545-7845
4102 Wakefield Blvd
Alexandria, LA 71303
2905 Horseshoe Dr
Alexandria, LA 71301
Phone (318) 545-7847
800 Ola St
Alexandria, LA 71303
3348 Highway 457
Alexandria, LA 71302
310 Richmond Dr
Alexandria, LA 71302
4800 Dawn St
Alexandria, LA 71301
601 Cloverleaf Blvd
Alexandria, LA 71303
Phone (318) 442-0878
2101 Vance Ave
Alexandria, LA 71301
Phone (318) 693-1303
3100 Jones Ave
Alexandria, LA 71302
1319 Bush Ave
Alexandria, LA 71301
1587 N Bolton Ave
Ste 1100
Alexandria, LA 71303
Phone (318) 445-9823
4500 Lincoln Rd
Alexandria, LA 71302
Phone (318) 545-7843
2727 Jones Ave
Alexandria, LA 71302
Phone (318) 209-4510
4645 Lincoln Rd
Alexandria, LA 71302
Phone (318) 545-7844
3111 Jones Ave
Alexandria, LA 71302
505 Texas Ave
Alexandria, LA 71301
Phone (318) 704-6283
5700 Prescott Rd
Alexandria, LA 71301
Phone (318) 545-7846
122 Maryland Ave
Alexandria, LA 71301
Phone (318) 628-0088
4310 Pardue Rd
Ball, LA 71405
Phone (318) 545-6414
89 Camp Livingston Rd
Ball, LA 71405
Phone 3186480375228
340 Webb Smith Dr
Colfax, LA 71417
Phone (318) 627-3700
646 Highway 1207
Deville, LA 71328
Phone (318) 545-6416
642 Highway 1207
Deville, LA 71328
Phone (318) 545-6416
7362 Highway 112
Elmer, LA 71424
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CEDCAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP09522 | LA | Yes |
Addresses
Primary practice location
1007 Sycamore St Ste B
Cottonport, LA 71327-3403
Mailing address
1007 Sycamore St Ste B
Cottonport, LA 71327-3403
Phone (800) 462-0742
Other practice location 1
1007 Sycamore St Ste B
Cottonport, LA 71327-3403
Phone (800) 462-0742 ext. 150
Other practice location 2
1007 Sycamore St Ste B
Cottonport, LA 71327-3403
Phone (800) 462-0742 ext. 150
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2452657 | Medicaid | LA |
Other names
- Kristen Michelle Bordelon
Other providers in Cottonport, LA
- A B C Transport Service L.L.C.
- Lasandra Augustine
- Avoyelles Women'S Healthcare, LLC
- Dustin Borrel
- Jeanne Cancienne
- CLHG-Avoyelles LLC
- Cottonport Corner Drug LLC
- Eddie'S Pharmacy, Inc.
All providers in Cottonport, LA · Family Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.