Healthcare Provider Details

I. General information

NPI: 1477486173
Provider Name (Legal Business Name): JILLIAN LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 1000
BATON ROUGE LA
70808-4370
US

IV. Provider business mailing address

9320 SOUTHLAWN DR
BATON ROUGE LA
70810-2684
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-3900
  • Fax:
Mailing address:
  • Phone: 225-276-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number220101
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: