Provider Demographics
NPI:1649573932
Name:LONG, RUTHIE ANITA (APRN)
Entity Type:Individual
Prefix:MS
First Name:RUTHIE
Middle Name:ANITA
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:64629 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-3611
Mailing Address - Country:US
Mailing Address - Phone:985-863-7100
Mailing Address - Fax:985-863-0085
Practice Address - Street 1:64629 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-3611
Practice Address - Country:US
Practice Address - Phone:985-863-7100
Practice Address - Fax:985-863-0085
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN102300 APO6121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05922233Medicaid
LA2145720Medicaid
LA403975YH3VMedicare PIN