JACKSON STREET PEDIATRICS, LLC (NPI# 1205454774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205454774 |
| Entity Type | Organization |
| Organization Name | JACKSON STREET PEDIATRICS, LLC |
| Practice Address |
5716 Jackson St Alexandria LA 71303-2042 |
| Mailing Address |
6326 Windy Oaks Alexandria LA 71301-2966 |
| Practice Telephone | 3187676503 |
| Practice Fax Number | 3187038257 |
| Mailing Telephone | 3133003637 |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2020-07-10 |
| Authorized Official Name | KAI A WICKER-BROWN (OWNER) |
| Authorized Official Telephone | 3133003637 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Street Address |
5716 JACKSON ST |
| City | ALEXANDRIA |
| State | LA |
| Zip Code | 71303-2042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346877370 | Victoria Bowie | Peer Specialist | 1405 Peterman Drive Suite A, Alexandria, LA 71303 | 2020-03-27 |
| 1396375051 | Christin Authement | Social Worker | 8326 Kelwood Avenue, Alexandria, LA 71303 | 2020-01-22 |
| 1164904520 | Carissa A Sorenson | Pharmacist | 4448 Jackson St, Alexandria, LA 71303 | 2018-09-02 |
| 1144731027 | Bradly Herman | Counselor | 1450 Peterman Drive, Alexandria, LA 71303 | 2017-10-18 |
| 1669991915 | Rashika Holmes | Counselor | 1538 Chase Dr, Alexandria, LA 71303 | 2017-09-18 |
| 1215466594 | Terraniecya Shepherd | Case Manager/Care Coordinator | 700 Veterans Dr. Apt. 608, Alexandria, LA 71303 | 2017-06-08 |
| 1427587864 | Jason Micheal Lachica | Counselor | 3921 Indpendence Drive Ste 104, Alexandria, LA 71303 | 2017-06-08 |
| 1669929188 | Ryan Knoll | Chiropractor | 5419 Jackson St. Ext. Suite B, Alexandria, LA 71303 | 2016-09-01 |
| 1023464393 | Heart of Hospice, LLC | Hospice Care, Community Based | 1001 Bayou Pl, Alexandria, LA 71303 | 2016-05-05 |
| 1770947764 | Jiquiah White | Counselor | 2016 Innis Dr, Alexandria, LA 71303 | 2016-04-06 |
| Find all providers in zip 71303 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205221942 | Carlos A. Cruz, Md, PC | Pediatrics | 1707 Osage St Ste 303, Alexandria, VA 22302-2611 | 2015-03-31 |
| 1447508163 | Arnold Jay Zedd | Pediatrics | 2621 Jamestown Lane, #203, Alexandria, VA 22314-5882 | 2012-08-28 |
| 1104102987 | Reynaldo Fraga | Pediatrics | 4518 Seminary Road, Juan R. Fraga M.d., Alexandria, VA 22304 | 2011-10-25 |
| 1144417544 | Chandanjeet Sidhu | Pediatrics | 2616 Sherwood Hall Ln Ste 106, Alexandria, VA 22306-3154 | 2007-09-29 |
| 1780886481 | Cathy Southammakosane | Pediatrics | 1500 N Beauregard St Ste 200, Alexandria, VA 22311-1700 | 2007-06-04 |
| 1215156898 | Rhodes Pediatric Clinic | Pediatrics | 37 Calvert Dr, Alexandria, LA 71303-3520 | 2007-04-24 |
| 1346363769 | Robert Bregman | Pediatrics | 4480 King St., Alex Health Dept, Alexandria, VA 22302 | 2007-04-09 |
| 1013035575 | Emily B Remus | Pediatrics | 1451 Belle Haven Rd Ste 110, Alexandria, VA 22307-1201 | 2007-03-26 |
| 1598880791 | Terri W Cummings | Pediatrics | 3628 Ransom Pl, Alexandria, VA 22306-1473 | 2007-03-20 |
| 1174690747 | Katherine Anne Tulenko | Pediatrics | 6402 15th St, Alexandria, VA 22307-1409 | 2006-11-29 |
| Find all providers in ALEXANDRIA | ||||
| City | ALEXANDRIA |
| Zip Code | 71303 |
Please comment or provide details below to improve the information on JACKSON STREET PEDIATRICS, LLC.
| 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.