Healthcare Provider Details

I. General information

NPI: 1336170976
Provider Name (Legal Business Name): ARLENE RENEE LONG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S 2ND ST
HIAWATHA KS
66434-2774
US

IV. Provider business mailing address

300 UTAH ST
HIAWATHA KS
66434-2326
US

V. Phone/Fax

Practice location:
  • Phone: 785-742-7113
  • Fax: 785-742-3085
Mailing address:
  • Phone: 785-742-2131
  • Fax: 785-742-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-74817
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number74817
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: