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NPI Code Detail

MEDICARE: CAITLIN LONG

MEDICARE:   CAITLIN  LONG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1427633494
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAITLIN LONG
Provider Business Mailing Address
First Line : 7312 FOUNTAIN VILLAGE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4641
Country : US
Telephone Number : 256-520-9409
Fax Number :
Provider Business Practice Location Address
First Line : 7312 FOUNTAIN VILLAGE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4641
Country : US
Telephone Number : 256-520-9409
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2021
Last Update Date : 12/10/2025

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Directions to “ CAITLIN LONG ” Practice Location

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