Healthcare Provider Details

I. General information

NPI: 1164515169
Provider Name (Legal Business Name): JENNIFER ALLEN LONG R.N.C.,W.H.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 HOSPITAL DR STE 260
BOSSIER CITY LA
71111-1909
US

IV. Provider business mailing address

2449 HOSPITAL DR STE 260
BOSSIER CITY LA
71111-1909
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-7840
  • Fax: 318-212-7845
Mailing address:
  • Phone: 318-212-7840
  • Fax: 318-212-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN071817 AP04141
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP04141
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: