Basic Information
| Provider Information | |||||||||
| NPI: | 1750335782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | RUBY | ||||||||
| MiddleName: | IVA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IRVIN GILLEY | ||||||||
| OtherFirstName: | RUBY | ||||||||
| OtherMiddleName: | IVA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CRNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 8 | ||||||||
| Address2: | |||||||||
| City: | SICILY ISLAND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713680008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183895727 | ||||||||
| FaxNumber: | 3183894028 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 WHITE ST | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842173 | ||||||||
| FaxNumber: | 6012494234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 10/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | R564826 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 00018211 | 05 | MS | MEDICAID |