| Evernorth Care Providers - Tennessee Pc | |
|
301 Main St Ste 2200 Baton Rouge LA 70801-0014 | |
| (773) 292-4800 | |
| (312) 564-4059 |
| Full Name | Evernorth Care Providers - Tennessee Pc |
|---|---|
| Speciality | General Practice |
| Location | 301 Main St Ste 2200, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Grace V Blue (CREDENTIALING SR. MANAGER) |
| Authorized Official Contact | 7732924800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evernorth Care Providers - Tennessee Pc 730 Cool Springs Blvd Ste 500 Franklin TN 37067-7331 Ph: (773) 292-4800 | Evernorth Care Providers - Tennessee Pc 301 Main St Ste 2200 Baton Rouge LA 70801-0014 Ph: (773) 292-4800 |
| NPI Number | 1215717319 |
|---|---|
| Provider Enumeration Date | 10/05/2023 |
| Last Update Date | 02/14/2024 |
| Medicare PECOS PAC ID | 7911355532 |
|---|---|
| Medicare Enrollment ID | O20240313003794 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215717319 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Dwone L Marshall-brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164791802 PECOS PAC ID: 8022272533 Enrollment ID: I20120613000622 |
| Provider Name | Francheska D Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639593379 PECOS PAC ID: 4082919469 Enrollment ID: I20160223001009 |
| Provider Name | Ariel D Graham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710414719 PECOS PAC ID: 7315216553 Enrollment ID: I20170703001504 |
| Provider Name | Shamelle Beaulieu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306369616 PECOS PAC ID: 2466710421 Enrollment ID: I20171220001338 |
| Provider Name | Lisa Deshun Smart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790291342 PECOS PAC ID: 6406118215 Enrollment ID: I20180314001969 |
| Provider Name | Wendy King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700366655 PECOS PAC ID: 1759629405 Enrollment ID: I20190205002355 |
| Provider Name | Nikura Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194343814 PECOS PAC ID: 3476971763 Enrollment ID: I20200918000882 |
| Provider Name | Lasonya Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003488164 PECOS PAC ID: 3173913365 Enrollment ID: I20211202000103 |
| Provider Name | Ashontis V Keys |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023787132 PECOS PAC ID: 2860886033 Enrollment ID: I20220304000099 |
| Provider Name | Megan Tania Clemons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225753619 PECOS PAC ID: 7810368628 Enrollment ID: I20230113000436 |
| Provider Name | Tunya S Jack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508324047 PECOS PAC ID: 4789049552 Enrollment ID: I20230501000416 |
| Provider Name | Jalaina Guidry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124719919 PECOS PAC ID: 0143675215 Enrollment ID: I20231010000296 |
| Provider Name | Leslie Diane Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518737436 PECOS PAC ID: 9638521230 Enrollment ID: I20240119000315 |
| Provider Name | Shannon Alsop |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003043803 PECOS PAC ID: 7517121742 Enrollment ID: I20240222000173 |
| Provider Name | Cheryl Hilton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184677742 PECOS PAC ID: 4082683651 Enrollment ID: I20240313003843 |
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