Healthcare Provider Details

I. General information

NPI: 1750335782
Provider Name (Legal Business Name): RUBY IVA WARD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUBY IVA IRVIN GILLEY CRNP

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SERIO BLVD
FERRIDAY LA
71334-2013
US

IV. Provider business mailing address

PO BOX 8
SICILY ISLAND LA
71368-0008
US

V. Phone/Fax

Practice location:
  • Phone: 318-389-5727
  • Fax: 318-389-9943
Mailing address:
  • Phone: 318-389-5727
  • Fax: 318-389-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR564826
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: