Individual provider Active NPI

Marilyn Gribble Holland, APRN

  • Family Nurse Practitioner
  • Lake Charles, LA
National Provider Identifier
1861932154
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP09148 Issued in LA
Practice address
2770 3Rd Ave Ste 110
Lake Charles, LA 70601-0404
Phone
(337) 494-4747
Fax
(337) 494-4773
NPI assigned
Mar 6, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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 AP09148 LA Primary

Addresses

Primary practice location

2770 3Rd Ave Ste 110
Lake Charles, LA 70601-0404

Mailing address

PO Box 122425 Dept 2425
Dallas, TX 75312-2425
Phone (337) 494-2921

Other practice location 1

2770 3rd Ave Ste 120
Lake Charles, LA 70601-8994
Phone (337) 494-4868

Other identifiers 2

IdentifierTypeStateIssuer
AP09148OtherLASTATE LICENSE
2441612MedicaidLA

Other names 1

  • Marilyn Francis Gribble Former name

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
I20170418002619 LA Practitioner - Nurse Practitioner 4082990403 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
LCMS Surgical Associates of Southwest Lousiana, LLCGroup PAC ID 8820113780, 7 clinicians

Practice addresses (Care Compare)

2770 3Rd Ave
Suite 120
Lake Charles, LA 70601-8994
Phone (337) 494-4868

Hospital & facility affiliations

  • Lake Charles Memorial Hospital Hospital, Lake Charles, LA, CCN 190060

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP09148LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
LCMS Surgical Associates of Southwest Lousiana, LLC CurrentSince Jun 1, 2022 Accepting new patients

Locations

2770 3rd Ave
Ste 110
Lake Charles, LA 70601
Phone (337) 494-2750

2770 3rd Ave
Ste 120
Lake Charles, LA 70601
Phone (337) 494-4868

Organizations & group practices 1

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1861932154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122425 DEPT 2425",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753122425",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 3RD AVE STE 110",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706010404",
            "telephone_number": "337-494-4747",
            "fax_number": "337-494-4773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2770 3rd Ave Ste 120",
            "address_purpose": "LOCATION",
            "city": "Lake Charles",
            "state": "LA",
            "postal_code": "706018994",
            "country_code": "US",
            "telephone_number": "337-494-4868",
            "fax_number": "337-494-4870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "MARILYN",
        "middle_name": "GRIBBLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-06",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP09148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "AP09148",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2441612",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARILYN",
            "last_name": "GRIBBLE",
            "middle_name": "FRANCIS",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.