Healthcare Provider Details

I. General information

NPI: 1740005750
Provider Name (Legal Business Name): JAMIE LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 MAPLE AVE
OAK HILL WV
25901-3475
US

IV. Provider business mailing address

504 HILLCREST ESTATES RD
PETERSTOWN WV
24963-5010
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: