Healthcare Provider Details

I. General information

NPI: 1871744607
Provider Name (Legal Business Name): CATHERINE ELLEN LONGSHORE APRN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 11/23/2023
Certification Date: 11/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OYSTER REEF DR
HILTON HEAD ISLAND SC
29926-2621
US

IV. Provider business mailing address

15 OYSTER REEF DR
HILTON HEAD ISLAND SC
29926-2621
US

V. Phone/Fax

Practice location:
  • Phone: 859-444-7430
  • Fax:
Mailing address:
  • Phone: 843-338-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1055765
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number27925
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27925
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: