Healthcare Provider Details

I. General information

NPI: 1598156044
Provider Name (Legal Business Name): ASHTON RECHELLE LONG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 HARTFORD AVENUE
JOHNSTON RI
02919
US

IV. Provider business mailing address

1126 HARTFORD AVENUE
JOHNSTON RI
02919
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-2750
  • Fax: 401-351-6611
Mailing address:
  • Phone: 401-351-2750
  • Fax: 401-351-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN00010
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN00010
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: