SHASTA BODDIE (NPI# 1538668538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538668538 |
| Entity Type | Individual |
| Full Name | SHASTA BODDIE |
| Practice Address |
555 Saint Tammany St Ste D Baton Rouge LA 70806-6064 |
| Mailing Address |
1301 Youree Dr Shreveport LA 71101-5117 |
| Practice Telephone | 2259299738 |
| Mailing Telephone | 3186750804 |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2018-02-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
555 SAINT TAMMANY ST STE D |
| City | BATON ROUGE |
| State | LA |
| Zip Code | 70806-6064 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790164366 | Corey Jenkins | Counselor | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2015-05-28 |
| 1013474154 | Adriana Hasley | Counselor | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2019-02-25 |
| 1912406935 | Holly Williams | Peer Specialist | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2018-02-05 |
| 1699274787 | Janice Rogers | Peer Specialist | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2018-02-05 |
| 1831698836 | Oddis Dunbar Jr. | Peer Specialist | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2018-02-05 |
| 1851890941 | Darnell Rogers | Peer Specialist | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2018-02-05 |
| 1649779653 | Regina Howard | Peer Specialist | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2018-02-05 |
| 1568961662 | Tara Eckles | Peer Specialist | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2018-02-05 |
| 1104325117 | Jerome Newsome | Peer Specialist | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2018-02-05 |
| 1386143394 | Sabrina Johnson | Peer Specialist | 555 Saint Tammany St Ste D, Baton Rouge, LA 70806-6064 | 2018-02-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467064790 | Horizon Network LLC | Community/Behavioral Health | 921 Lobdell Blvd Suite D, Baton Rouge, LA 70806 | 2020-08-18 |
| 1093324220 | Raghu Rudraraju | Student in an Organized Health Care Education/Training Program | 3401 North Boulevard Baton Rouge General Mid City Medi, Suite 130, Baton Rouge, LA 70806 | 2020-07-23 |
| 1619595584 | Brown's Pharmacy, LLC | Pharmacy | 1718 North Foster Drive, Suite B, Baton Rouge, LA 70806 | 2020-07-08 |
| 1497374847 | Yara Mouawad | Student in an Organized Health Care Education/Training Program | 3401 North Boulevard, Suite 130, Baton Rouge, LA 70806 | 2020-04-15 |
| 1396364527 | Sai Samyuktha Bandaru | Student in an Organized Health Care Education/Training Program | Brg Mid City Medicine Clinic, 3401 North Boulevard, Sui, Baton Rouge, LA 70806 | 2020-04-08 |
| 1588299812 | Iraneeka S Gustave | Peer Specialist | Kelwood Ave, 8326 Kelwood Ave, Baton Rouge, LA 70806 | 2020-03-06 |
| 1518522192 | Silpita Katragadda | Student in an Organized Health Care Education/Training Program | 3401 North Boulevard, Brg Midcity Medicine Clinic, Suite 130, Baton Rouge, LA 70806 | 2019-05-08 |
| 1437713997 | Dental Solutions, LLC | Dentist | 5629 Government St, Baton Rouge, LA 70806 | 2019-04-30 |
| 1699249516 | Shea Lafountain | Counselor | 624 Connell's Park Lane, Baton Rouge, LA 70806 | 2019-01-14 |
| 1033682802 | Genesis Specialty Groups, LLC | Clinic/Center | 778 Chevelle Drive, Baton Rouge, LA 70806 | 2019-01-04 |
| Find all providers in zip 70806 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588299812 | Iraneeka S Gustave | Peer Specialist | Kelwood Ave, 8326 Kelwood Ave, Baton Rouge, LA 70806 | 2020-03-06 |
| 1770107310 | Cenea Taylor | Peer Specialist | 8326 Kelwood Ave, Baton Rouge, LA 70806-4803 | 2020-05-29 |
| 1558984195 | Mariam Rubio | Peer Specialist | 8326 Kelwood Ave, Baton Rouge, LA 70806-4803 | 2020-05-18 |
| 1518589837 | Michael Thomas | Peer Specialist | 8326 Kelwood Ave, Baton Rouge, LA 70806-4803 | 2020-05-08 |
| 1518589035 | Jordan D Johnson | Peer Specialist | 8326 Kelwood Ave, Baton Rouge, LA 70806-4803 | 2020-05-07 |
| 1548881089 | Diamond Gustave | Peer Specialist | 8326 Kelwood Ave, Baton Rouge, LA 70806-4803 | 2020-05-06 |
| 1639790470 | Ontranekia Juni Nixon | Peer Specialist | 8326 Kelwood Ave, Baton Rouge, LA 70806-4803 | 2020-05-04 |
| 1780213900 | Amanda Marie Mosshammer | Peer Specialist | 8326 Kelwood Ave, Baton Rouge, LA 70806-4803 | 2020-04-08 |
| 1184259665 | Marah Bowie | Peer Specialist | 8326 Kelwood Ave, Baton Rouge, LA 70806-4803 | 2020-03-05 |
| 1194350702 | Angel Norwood | Peer Specialist | 8326 Kelwood Ave, Baton Rouge, LA 70806-4803 | 2020-03-04 |
| Find all providers in BATON ROUGE | ||||
| City | BATON ROUGE |
| Zip Code | 70806 |
Please comment or provide details below to improve the information on SHASTA BODDIE.
| 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.