Provider Demographics
NPI:1164515169
Name:LONG, JENNIFER ALLEN (RNC,WHNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALLEN
Last Name:LONG
Suffix:
Gender:F
Credentials:RNC,WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 HOSPITAL DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2401
Mailing Address - Country:US
Mailing Address - Phone:318-212-7973
Mailing Address - Fax:318-212-7836
Practice Address - Street 1:2400 HOSPITAL DR STE 400
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2401
Practice Address - Country:US
Practice Address - Phone:318-212-7973
Practice Address - Fax:318-212-7836
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN071817 AP04141363LX0001X
LAAP04141363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1133850Medicaid
LAP67654Medicare UPIN
LA4C381Medicare ID - Type UnspecifiedMEDICARE #