MR. JEREMY LAWRENCE RUSSELL PA-C NPI 1639808306

NPI Information

  • NPI: 1639808306
  • Provider Name: MR. JEREMY LAWRENCE RUSSELL, PA-C
  • Classification: Physician Assistant - 363AS0400X
  • Specialization: Surgical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 15790 PAUL VEGA MD DR
    HAMMOND, LA
    ZIP 70403
  • Phone: (985) 345-2700

Map and Directions

Get Directions

NPI Details

MR. Jeremy Lawrence Russell, PA-C is a surgical physician assistant in Hammond, LA with 3 years of experience. MR. Jeremy Lawrence Russell, PA-C NPI is 1639808306. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS
Graduation Year:2022

The provider's business location address is:

15790 PAUL VEGA MD DR
HAMMOND, LA
ZIP 70403-436
Phone: (985) 345-2700
Fax: (985) 230-6653

The NPI 1639808306 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/8/2022 and was last updated on 6/8/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician Assistant1196694LOUISIANANo
2363AS0400XPhysician AssistantSurgical332993LOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11639808306OTHERLOUISIANANPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI