Louella M Jackson, FNPC
Individual provider Active NPI Family Nurse Practitioner · Lake Charles, LA
NPI 1871630004 · NPPES record last updated Aug 1, 2018
Key facts
- NPI
- 1871630004
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP03007 (LA)
- Practice address
- 2000 Opelousas St
Lake Charles, LA 70601 - Phone
- (337) 439-9983
- Fax
- (337) 439-8898
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- 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 |
|---|---|---|---|---|
| I20171130001206 | ND | Practitioner - Nurse Practitioner | 9234157850 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP03007 | LA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elbowoods Memorial Health Center | Current |
Accepting new patients | |
| Healthcare 1 | Past | Accepting new patients |
Locations
1058 College Dr
New Town, ND 58763
Phone (701) 627-4750
1251 Elbowoods Loop
New Town, ND 58763
Phone (701) 627-4750
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP03007 | LA | Yes |
Addresses
Primary practice location
2000 Opelousas St
Lake Charles, LA 70601
Mailing address
2000 Opelousas St
Lake Charles, LA 70601-2641
Phone (337) 439-9983
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1691810 | Medicaid | LA |
Other providers in Lake Charles, LA
- J Lene Jackson
- Jada Jackson
- James Jackson
- Kelechi Ihuoma Jackson
- Kenneth Lee Jackson
- Naomi Jefferson Jackson
- Shameka Jackson
- Jacob Dent DDS Dentists of Lake Charles a Proffessional Corporation
- Brenna Thomas Jacob
- Jennifer Colleen Flavin Jacobs
All providers in Lake Charles, 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 Aug 1, 2018. 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.