Provider Demographics
NPI:1467178244
Name:RITCH, MACENSIE LEIGH (RN)
Entity type:Individual
Prefix:
First Name:MACENSIE
Middle Name:LEIGH
Last Name:RITCH
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:MACENSIE
Other - Middle Name:LEIGH
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10151 KELLI LEANNE CIR
Mailing Address - Street 2:
Mailing Address - City:KEITHVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71047-7579
Mailing Address - Country:US
Mailing Address - Phone:318-540-4842
Mailing Address - Fax:
Practice Address - Street 1:3023 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-9441
Practice Address - Country:US
Practice Address - Phone:318-564-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAR-11388106S00000X
LA229361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA229361OtherLOUISIANA STATE BOARD OF NURSING
RBT-22-238927OtherBACB