Healthcare Provider Details

I. General information

NPI: 1275336612
Provider Name (Legal Business Name): SHARON KAY LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 RIKE DR
PINE BLUFF AR
71603-3935
US

IV. Provider business mailing address

2410 RIKE DR
PINE BLUFF AR
71603-3935
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-2035
  • Fax: 870-534-2058
Mailing address:
  • Phone: 870-534-2035
  • Fax: 870-534-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR043278
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: