Doctor Name: | JENNIFER LEEANN LONG |
NPI Number: | 1013223130 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | ATP-000303 |
Business Practice Address: | 1009 Highway 18 Lake City, AR - 724379622 |
Business Phone Number: | 8702379928 |
Business Fax Number: | 8702371012 |
Mailing Address: | 117 S 2nd St, Po Box 497 AUGUSTA |
State: | AR |
Postal Code: | 720062309 |
Phone Number: | 8703472534 |
Fax Number: | 8703473492 |
NPI Enumeration Date: | 08/26/2010 |
NPI Last Update Date: | 01/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | ATP-000303 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |