| Doctor Name: | BETHANY LONGINO SHIRLEY |
| NPI Number: | 1255617296 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN, NP-C |
| License Number: | RN112542-AP06651 |
| Business Practice Address: | 106 Mimosa St Amite, LA - 704222136 |
| Business Phone Number: | 9856461579 |
| Business Fax Number: | |
| Mailing Address: | 27395 Fred Thomas Rd, FRANKLINTON |
| State: | LA |
| Postal Code: | 704385261 |
| Phone Number: | 9858399512 |
| Fax Number: | |
| NPI Enumeration Date: | 10/21/2011 |
| NPI Last Update Date: | 10/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN112542-AP06651 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |