Jaimie Desroche Revon, LPN

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

700 Gause Blvd Ste 201
Slidell, LA 70458-2853

Phone

(504) 330-6670

NPI assigned

Aug 3, 2020

Last updated

Aug 3, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1881204022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 GAUSE BLVD STE 201",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 GAUSE BLVD STE 201",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582853",
            "telephone_number": "504-330-6670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVON",
        "first_name": "JAIMIE",
        "middle_name": "DESROCHE",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-03",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "LA",
            "license": "2-0160813",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881864",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jaimie.revon@pathways.com",
            "affiliation": "N",
            "endpointDescription": "work email, secured",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "700 Gause Blvd Ste 201",
            "city": "Slidell",
            "state": "LA",
            "country_code": "US",
            "postal_code": "704582853",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jaimie.revon@pathways.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "700 Gause Blvd Ste 201",
            "city": "Slidell",
            "state": "LA",
            "country_code": "US",
            "postal_code": "704582853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Renal Treatment Centers-Southeast, LP. (Slidell Kidney Care)
• Renewed Hope Center, Inc. (The Blooming Tree)
• Resilient Transportation L3C
• Respiratory Services, Inc.
• Restorative Prosthetics & Orthotics
• Maria Reyes
• Maria Elena Reymundo, LCSW
• Amanda Reynolds
• Temechius La'Trece Reynolds
• Heather S. Rezza, FNP

• Case Manager/Care Coordinator in Slidell, LA
• Providers in Slidell, LA by specialty
• Case Manager/Care Coordinator in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.