JADEBREY VYSHETTE KENNON (NPI# 1518574441) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518574441 |
| Entity Type | Individual |
| Full Name | JADEBREY VYSHETTE KENNON |
| Credential | PMHNP-BC |
| Practice Address |
1541 Kings Hwy Shreveport LA 71103-4228 |
| Mailing Address |
2506 Sundsvall Ct Shreveport LA 71118-4520 |
| Practice Telephone | 3186260000 |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2020-09-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
212198 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1541 KINGS HWY |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-4228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912909912 | Brfhh Shreveport LLC | General Acute Care Hospital | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2005-08-10 |
| 1851991947 | Gina Marie Kristiansen | Nurse Practitioner | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-10-28 |
| 1376142893 | Candice Crow | Internal Medicine | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-10-26 |
| 1629683230 | Amanda Renae Simmons | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-10 |
| 1255945382 | Frank James List | Pharmacy Technician | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-05 |
| 1700496312 | Caroline Leigh Harris | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-08-07 |
| 1740899400 | Brittany Allyson Bozzell | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-07-29 |
| 1386253169 | Kristyn Turner | Pharmacist | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-07-28 |
| 1508481722 | Alexandra Blair Lemaire | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-06-12 |
| 1508481953 | Amy Deneal Lewing | Nurse Practitioner | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-06-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942660287 | Larry David Allen Jr. | Nurse Practitioner | 4416 Orchid St, Shreveport, LA 71105-3130 | 2016-02-29 |
| 1912389503 | Lisa Jones Baker | Nurse Practitioner | 1002 Highland Ave Fl 2, Shreveport, LA 71101-4143 | 2015-06-19 |
| 1407264989 | Jaschandria Bailey | Nurse Practitioner | Brentwood Hospital, 1006 Highland Avenue, Shreveport, LA 71101-4202 | 2014-07-28 |
| 1851493829 | Susan M Derivas | Nurse Practitioner | 1651 E 70th St # 382, Shreveport, LA 71105-5115 | 2006-09-01 |
| 1740801752 | Mitsi Tonette Long | Nurse Practitioner | 3341 Youree Dr Ste 205, Shreveport, LA 71105-2149 | 2020-04-30 |
| 1104471382 | Juanita Carolyn Roberts | Nurse Practitioner | 1006 Highland Ave, Shreveport, LA 71101-4103 | 2019-08-05 |
| 1841792249 | James G Jones IIi | Nurse Practitioner | 1002 Highland Ave, Shreveport, LA 71101-4143 | 2018-03-02 |
| 1225539984 | Marnitta Demming | Nurse Practitioner | 7591 Fern Ave Ste 1705, Shreveport, LA 71105-5749 | 2018-02-27 |
| 1912417262 | Janey Gaston | Nurse Practitioner | 8731 Park Plaza Dr, Shreveport, LA 71105-5682 | 2017-10-01 |
| 1043601685 | Psychiatric Nurse Practitioner Services, LLC | Nurse Practitioner | 1651 E 70th St # 382, Shreveport, LA 71105-5115 | 2015-02-17 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
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| 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.