Healthcare Provider Details

I. General information

NPI: 1649700733
Provider Name (Legal Business Name): NANCY BOOTH-LONG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 PROBART ST
BREVARD NC
28712-6644
US

IV. Provider business mailing address

380 E MAIN ST
BREVARD NC
28712-3835
US

V. Phone/Fax

Practice location:
  • Phone: 828-226-1980
  • Fax:
Mailing address:
  • Phone: 828-490-2556
  • Fax: 336-852-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009562
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009562
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: