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NPI Code Detail

MEDICARE: SHERRIE R LONG NP

MEDICARE: SHERRIE R LONG NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianR804367MS
2363L00000XNurse Practitioner804367MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568533248
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHERRIE R LONG NP
Provider Business Mailing Address
First Line : 200 CORPORATE BLVD
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-3870
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1030 RIVER OAKS DR
Second Line :
City : JACKSON
State : MS
Zip : 39232-9553
Country : US
Telephone Number : 800-893-9698
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 12/09/2019

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