Provider Demographics
NPI:1477983062
Name:HEALTHCARE DIMENSIONS LLC
Entity Type:Organization
Organization Name:HEALTHCARE DIMENSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:337-678-1630
Mailing Address - Street 1:226 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-3346
Mailing Address - Country:US
Mailing Address - Phone:337-678-1630
Mailing Address - Fax:337-678-1635
Practice Address - Street 1:226 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-3346
Practice Address - Country:US
Practice Address - Phone:337-678-1630
Practice Address - Fax:337-678-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1563404Medicaid
LA4B540Medicare PIN
LA1563404Medicaid