Healthcare Provider Details

I. General information

NPI: 1477048874
Provider Name (Legal Business Name): WHITNEY RUST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S FARMERVILLE ST
RUSTON LA
71270-5941
US

IV. Provider business mailing address

142 RUE MARGUERITE
THIBODAUX LA
70301-6708
US

V. Phone/Fax

Practice location:
  • Phone: 318-255-3690
  • Fax: 318-251-6116
Mailing address:
  • Phone: 985-446-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10089
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN143026
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: