Provider Demographics
NPI:1316905789
Name:HEARNE, ROBERT CULLEN (RN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CULLEN
Last Name:HEARNE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-0098
Mailing Address - Country:US
Mailing Address - Phone:318-251-4151
Mailing Address - Fax:318-251-4177
Practice Address - Street 1:901 WHITE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5960
Practice Address - Country:US
Practice Address - Phone:318-251-4150
Practice Address - Fax:318-251-4177
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN042404163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710342Medicaid
LA5C144Medicare ID - Type Unspecified