Basic Information
| Provider Information | |||||||||
| NPI: | 1174596910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SESSIONS | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 401 11TH ST NE | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710754503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185391700 | ||||||||
| FaxNumber: | 3185395688 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 11TH ST NE | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710754503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185391700 | ||||||||
| FaxNumber: | 3185395688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11639 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1156353 | 05 | LA | MEDICAID | 11639 | 01 | LA | LSBME LICENSE | OTHER | 88006 | 01 | AR BLUE CROSS | OTHER | 118143001 | 05 | AR | MEDICAID | 4982 | 01 | LA CDS | OTHER | AS8633655 | 01 | DEA | OTHER |