BRADLEY LANE JIMERSON (NPI# 1013579150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013579150 |
| Entity Type | Individual |
| Full Name | BRADLEY LANE JIMERSON |
| Credential | DPM |
| Practice Address |
1747 Imperial Blvd Lake Charles LA 70605-5362 |
| Mailing Address |
1727 Imperial Blvd. Bldg. 1 Suite A Lake Charles LA 70605 |
| Practice Telephone | 3377217236 |
| Practice Fax Number | 3377217237 |
| Mailing Telephone | 3374804953 |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2019-06-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | PO9593 | LA | Student, Health Care |
| Street Address |
1747 IMPERIAL BLVD |
| City | LAKE CHARLES |
| State | LA |
| Zip Code | 70605-5362 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487649091 | Staci Simon Boudreaux | Physician Assistant | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2005-09-20 |
| 1376168971 | Cody Gaupel | Student in an Organized Health Care Education/Training Program | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2020-06-10 |
| 1538703335 | Center for Orthopaedics and Spine LLC | Family Medicine | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2019-11-05 |
| 1912560541 | Haley Cook Cart | Physician Assistant | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2019-04-18 |
| 1174014534 | Susan Helms Cart | Occupational Therapist | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2018-05-22 |
| 1679071161 | Ashley A Nix | Registered Nurse | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2018-01-30 |
| 1235584004 | Matthew Mccabe | Podiatrist | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2016-04-29 |
| 1295100808 | Lauren Ashley Sexton | Specialist/Technologist | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2015-12-08 |
| 1326422924 | Lance Henagan | Nurse Practitioner | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2015-07-13 |
| 1659754463 | Brittni Granger Law | Nurse Practitioner | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2015-06-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780283606 | Kristin R Morris | Clinical Nurse Specialist | 1900 W. Gaythier Rd, Lake Charles, LA 70605 | 2020-10-21 |
| 1548871577 | Jacob M Theriot | Nurse Practitioner | 2640 County Club Rd., Lake Charles, LA 70605 | 2020-08-13 |
| 1053898403 | Heather Spallino Duplechain | Nurse Practitioner | 6713 Nelson Rd., Lake Charles, LA 70605 | 2018-07-27 |
| 1578057956 | Noor Deeb Weckerly | Nurse Practitioner | 6713 Nelson Rd, Lake Charles, LA 70605 | 2018-06-19 |
| 1861993354 | Therapy Works of Swla LLC | Physical Therapist | 4750 Lake Street, Lake Charles, LA 70605 | 2018-02-21 |
| 1669998852 | Amd Healthcare Lc, LLC | General Acute Care Hospital | 3730 Nelson Road, Lake Charles, LA 70605 | 2017-08-18 |
| 1619422474 | Kaitlyn Pinkerton | Specialist/Technologist | 800 E Mcneese St, Lake Charles, LA 70605 | 2016-08-22 |
| 1104274679 | Kelly Rogers | Counselor | 90 N. Luke 102l, Lafayette, LA 70605 | 2016-05-25 |
| 1548616220 | Lisa Monticello Snider | Neurological Surgery | 3297 Portrush Drive, Lake Charles, LA 70605 | 2016-05-11 |
| 1114387404 | Louisiana Dental Professionals, Donovan Dronet, Dds, A Professional De | Dentist | 4459 Nelson Rd, Suite 120, Lake Charles, LA 70605 | 2016-02-29 |
| Find all providers in zip 70605 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710596283 | Dakota Loosemore | Student in an Organized Health Care Education/Training Program | 800 East Mcneese Street, Lake Charles, LA 70607 | 2020-07-30 |
| 1417512070 | Ryan Nathaniel Vaisler | Student in an Organized Health Care Education/Training Program | 1525 Oak Park Blvd., Lake Charles, LA 70601 | 2019-05-08 |
| 1386104115 | Jessica Marie Miglicco Cole | Student in an Organized Health Care Education/Training Program | 714 Chay Dr, Lake Charles, LA 70611-4957 | 2019-03-19 |
| 1699156901 | Joel Romance | Student in an Organized Health Care Education/Training Program | 5659 Chuck Dr, Lake Charles, LA 70605-5271 | 2015-06-11 |
| 1730389933 | Jason R. Egloff | Student in an Organized Health Care Education/Training Program | 1367 Mohican Dr, Lake Charles, LA 70611-4919 | 2007-07-25 |
| 1356967434 | Manpreet Mand | Student in an Organized Health Care Education/Training Program | 1525 Oak Park Blvd, Lake Charles, LA 70601 | 2020-06-24 |
| 1376168971 | Cody Gaupel | Student in an Organized Health Care Education/Training Program | 1747 Imperial Blvd, Lake Charles, LA 70605-5362 | 2020-06-10 |
| 1376162990 | Daniel Mark Seeser | Student in an Organized Health Care Education/Training Program | 1525 Oak Park Blvd, Lake Charles, LA 70601-8849 | 2020-04-14 |
| 1053940593 | Ifeoma Anagboso | Student in an Organized Health Care Education/Training Program | 1525 Oak Park Blvd, Lake Charles, LA 70601-8849 | 2020-04-06 |
| 1902434368 | Matthew Taylor | Student in an Organized Health Care Education/Training Program | 1525 Oak Park Blvd, Lake Charles, LA 70601-8849 | 2020-03-31 |
| Find all providers in LAKE CHARLES | ||||
| City | LAKE CHARLES |
| Zip Code | 70605 |
Please comment or provide details below to improve the information on BRADLEY LANE JIMERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.