Provider Demographics
NPI:1164665493
Name:LONG, VELDA SUE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:VELDA
Middle Name:SUE
Last Name:LONG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4276
Mailing Address - Country:US
Mailing Address - Phone:318-641-2000
Mailing Address - Fax:318-641-2261
Practice Address - Street 1:100 PINECREST DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4276
Practice Address - Country:US
Practice Address - Phone:318-641-2000
Practice Address - Fax:318-641-2261
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN40529 APO2957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily