Active NPI
Jennifer N Meserole, CST PA
- Surgical Physician Assistant
- Mandeville, LA
National Provider Identifier
1982811006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- CN067243
- Practice address
- 230 Audubon Dr
Mandeville, LA 70471 - Phone
- (985) 845-1501
- Fax
- (985) 845-1601
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | CN067243 | LA | Primary |
Addresses
Primary practice location
230 Audubon Dr
Mandeville, LA 70471
Mailing address
230 Audubon Dr
Mandeville, LA 70471
Phone (985) 845-1501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CN067243 | Other | LA | NAT C OF ASSIST SURG |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CN067243 | LA | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982811006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 AUDUBON DR",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "70471",
"telephone_number": "985-845-1501",
"fax_number": "985-845-1601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 AUDUBON DR",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "70471",
"telephone_number": "985-845-1501",
"fax_number": "985-845-1601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MESEROLE",
"first_name": "JENNIFER",
"middle_name": "N",
"name_prefix": "Mrs.",
"credential": "CST PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "LA",
"license": "CN067243",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NAT C OF ASSIST SURG",
"identifier": "CN067243",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mandeville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.