Healthcare Provider Details

I. General information

NPI: 1235788944
Provider Name (Legal Business Name): CLAIRE LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 INDIAN WELLS RD
ALAMOGORDO NM
88310
US

IV. Provider business mailing address

313 PALO DURO
ALAMOGORDO NM
88310
US

V. Phone/Fax

Practice location:
  • Phone: 540-229-2671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2025-0068
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: