Juanetta Martin, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

900889 Issued in LA

Practice address

8057 Williard Rd
Bastrop, LA 71220-8939

Phone

(318) 556-0043

Fax

(318) 556-3633

NPI assigned

Jan 4, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Bayou Home Bureau Corporation

  • In Home Supportive Care Agency
  • Bastrop, LA
  • NPI 1841592300
  NPD (past) Authorized official

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1972650653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 561",
            "address_2": "8057 WILLARD ROAD",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712210561",
            "telephone_number": "318-556-0043",
            "fax_number": "318-556-3633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8057 WILLIARD RD",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712208939",
            "telephone_number": "318-556-0043",
            "fax_number": "318-556-3633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JUANETTA",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "LA",
            "license": "900889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1171506",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1564761",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mahmoud Sheikh-Khalil MD Apmc
• Shahzad M. Malik, M.D.
• Paula Manning, RPH
• Tikela Nawana Mansfield, MHP/CAS MANAGER
• Adam C Martin, O.T.
• Renarta Lashayla Martin
• Annie Massey
• Antionette Armetis Massey
• Jada Matlock
• Destinee Matthews, M.S.

• Licensed Practical Nurse in Bastrop, LA
• Providers in Bastrop, LA by specialty
• Licensed Practical Nurse in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.