Healthcare Provider Details

I. General information

NPI: 1497149264
Provider Name (Legal Business Name): STACEY LONGORIA PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 BIRKDALE CROSSING DR STE 300
HUNTERSVILLE NC
28078-8459
US

IV. Provider business mailing address

9525 BIRKDALE CROSSING DR STE 300
HUNTERSVILLE NC
28078-8459
US

V. Phone/Fax

Practice location:
  • Phone: 704-317-2930
  • Fax:
Mailing address:
  • Phone: 704-317-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022115
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: