Healthcare Provider Details

I. General information

NPI: 1366346876
Provider Name (Legal Business Name): TAYLOR LONG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N PLAZA BLVD
CHILLICOTHEE OH
45601-1761
US

IV. Provider business mailing address

835 BLACKSTONE ST
WASHINGTON COURT HOUSE OH
43160-1694
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-6801
  • Fax:
Mailing address:
  • Phone: 740-505-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0043511
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: