Provider Demographics
NPI:1649650854
Name:LONG, LAURA USNIK (WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:USNIK
Last Name:LONG
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-255-2660
Mailing Address - Fax:601-255-2645
Practice Address - Street 1:62 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8382
Practice Address - Country:US
Practice Address - Phone:601-544-4550
Practice Address - Fax:601-582-3373
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP08121363LW0102X
MSR882292363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health