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: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N LIMESTONE ST STE 175
SPRINGFIELD OH
45503-1111
US

IV. Provider business mailing address

2600 N LIMESTONE ST STE 175
SPRINGFIELD OH
45503-1111
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-9980
  • Fax: 937-523-9985
Mailing address:
  • Phone: 937-523-9980
  • Fax: 937-523-9985

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: