Healthcare Provider Details

I. General information

NPI: 1659097244
Provider Name (Legal Business Name): MISTY LONG MSN, APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISTY LONG

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W ILLINOIS AVE # 100
MIDLAND TX
79701-6384
US

IV. Provider business mailing address

600 N WASHINGTON AVE STE B
ODESSA TX
79761-4436
US

V. Phone/Fax

Practice location:
  • Phone: 432-699-2370
  • Fax:
Mailing address:
  • Phone: 432-363-4407
  • Fax: 432-224-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1096837
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: