| Collective Rural Healthcare System Llc | |
| 
					4855 Highway 10 West Suite C Elizabeth LA 70638  | |
| (318) 634-5600 | |
| (318) 634-5602 | 
| Full Name | Collective Rural Healthcare System Llc | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 4855 Highway 10 West, Elizabeth, Louisiana | 
| Authorized Official Name and Position | Alec Donovan Jeansonne (CEO) | 
| Authorized Official Contact | 3188802144 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Collective Rural Healthcare System Llc 912 Bryan St Cottonport LA 71327-4288 Ph: (888) 995-0591  | Collective Rural Healthcare System Llc 4855 Highway 10 West Suite C Elizabeth LA 70638 Ph: (318) 634-5600  | 
| NPI Number | 1841908761 | 
|---|---|
| Provider Enumeration Date | 11/09/2022 | 
| Last Update Date | 11/11/2022 | 
| Medicare PECOS PAC ID | 1254701121 | 
|---|---|
| Medicare Enrollment ID | O20230111000104 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1841908761 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary | 
| Provider Name | Herndon Martin Jeansonne | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1114002698 PECOS PAC ID: 3678587375 Enrollment ID: I20060202000098  | 
| Provider Name | Angela D Huval | 
|---|---|
| Provider Type | Practitioner - Clinical Social Worker | 
| Provider Identifiers | NPI Number: 1639489487 PECOS PAC ID: 4486808763 Enrollment ID: I20130214000368  | 
| Provider Name | Paula Gates | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1013264878 PECOS PAC ID: 6507092822 Enrollment ID: I20131115000224  | 
| Provider Name | Heather Johnson Palazzo | 
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist | 
| Provider Identifiers | NPI Number: 1114322146 PECOS PAC ID: 8820481716 Enrollment ID: I20220217002155  | 
| Provider Name | Misty Danielle Martin | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1427763085 PECOS PAC ID: 2769855923 Enrollment ID: I20230308003294  | 
| Provider Name | Ashley Sarah Farris | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1881471571 PECOS PAC ID: 9638525744 Enrollment ID: I20231026000288  | 
| Provider Name | Laurel Lachelle Sanders | 
|---|---|
| Provider Type | Practitioner - Mental Health Counselor | 
| Provider Identifiers | NPI Number: 1942865332 PECOS PAC ID: 9830541358 Enrollment ID: I20240122000144  |