Healthcare Provider Details

I. General information

NPI: 1548797608
Provider Name (Legal Business Name): SCOTT ALAN LONG CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HOSPITAL DR
DUBLIN OH
43016-8518
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-8000
  • Fax:
Mailing address:
  • Phone: 614-788-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.020942
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: