ALTRECIA L JACKSON (NPI# 1114459666) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114459666 |
| Entity Type | Individual |
| Full Name | ALTRECIA L JACKSON |
| Credential | LPN |
| Practice Address |
7209 Louise St Shreveport LA 71108-4844 |
| Mailing Address |
3341 Youree Drive Shreveport LA 71105 |
| Practice Telephone | 3183448365 |
| Mailing Telephone | 3183448365 |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2019-01-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 164W00000X | Licensed Practical Nurse | 880566 | LA | Nursing Service Providers |
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | LPN | 880566 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3341 Youree Dr, Shreveport, LA 711052149 | 3183448365 |
| Street Address |
7209 LOUISE ST |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71108-4844 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528551140 | Berkelia Player | Case Manager/Care Coordinator | 8108 Kingston Road Suite 101 B, Shreveport, LA 71108 | 2018-06-08 |
| 1548757305 | Kenya Cawthorne | Counselor | 1520 Oakdale St, Shreveport, LA 71108 | 2018-04-17 |
| 1083112890 | Chantanell Johns | Case Manager/Care Coordinator | 8101 Kingston Rd Ste 101b, Shreveport, LA 71108 | 2018-01-26 |
| 1912425935 | Mildred Rivers | Case Manager/Care Coordinator | 4718 Hearne Ave, Shreveport, LA 71108 | 2017-08-30 |
| 1790205326 | Britney Ashton | Case Manager/Care Coordinator | 1910 Hickory St, Shreveport, LA 71108 | 2017-06-24 |
| 1548792674 | La'travia Jackson | Case Manager/Care Coordinator | 3430 Fernwood Ln, Shreveport, LA 71108 | 2017-03-29 |
| 1962941476 | Johnetta Marshall | Counselor | 6901 Despot Rd, Shreveport, LA 71108 | 2017-02-16 |
| 1295283992 | Shaun Cooper | Case Manager/Care Coordinator | 8824 Ruth Ave, Shreveport, LA 71108 | 2016-09-12 |
| 1508313735 | Tara Black | Counselor | 7019 Louise St, Shreveport, LA 71108 | 2016-09-06 |
| 1659828960 | Maranda Bolden | Counselor | 4906 Merlin Circle, Apt 4906, Shreveport, LA 71108 | 2016-09-02 |
| Find all providers in zip 71108 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497360887 | Halena Jones | Case Manager/Care Coordinator | 9409 Chaparral Ln, Shreveport, LA 71118-4337 | 2020-09-11 |
| 1598376196 | Michaela Nicole Bradley | Case Manager/Care Coordinator | 10021 Stratmore Cir, Shreveport, LA 71115-3416 | 2020-08-17 |
| 1619585791 | Kimberly Bissell | Case Manager/Care Coordinator | 7505 Pines Rd Ste 1115, Shreveport, LA 71129-3900 | 2020-07-15 |
| 1902414170 | Unique Lashae Lister | Case Manager/Care Coordinator | 2611 Corbitt St, Shreveport, LA 71108-2805 | 2020-07-14 |
| 1407474828 | Angela Harris | Case Manager/Care Coordinator | 1111 W 70th St Apt 93, Shreveport, LA 71106-3558 | 2020-07-13 |
| 1669096921 | Ryan Barham | Case Manager/Care Coordinator | 824 Oneonta St, Shreveport, LA 71106-1130 | 2020-06-02 |
| 1922621085 | Julian White | Case Manager/Care Coordinator | 8529 Grover Pl, Shreveport, LA 71115-2707 | 2020-05-24 |
| 1396368817 | Shannon Marie Cannon | Case Manager/Care Coordinator | 1543 Summers St, Shreveport, LA 71108-3131 | 2020-05-19 |
| 1730701954 | Brianna Mason | Case Manager/Care Coordinator | 1533 Marshall St, Shreveport, LA 71101-3941 | 2020-05-11 |
| 1295355238 | Angela Rice | Case Manager/Care Coordinator | 2704 Frostwood Dr, Shreveport, LA 71108-5524 | 2020-04-20 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71108 |
Please comment or provide details below to improve the information on ALTRECIA L JACKSON.
| 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.