{
"Npi": {
"NPI": "1235895491",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LONG",
"FirstName": "KRYSTEL",
"MiddleName": "LEANN",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "PMHNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2151 CANDACE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LANCASTER",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75146-4946",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "121-488-1898",
"MailingAddressFaxNumber": "469-772-5503",
"FirstLinePracticeLocationAddress": "1301 E PARKERVILLE RD STE A8-1073",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DESOTO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75115-6420",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-222-9721",
"PracticeLocationAddressFaxNumber": "469-772-5503",
"EnumerationDate": "11/11/2021",
"LastUpdateDate": "09/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "1059580",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "364SP0809X",
"TaxonomyName": "Adult Psychiatric/Mental Health Clinical Nurse Specialist",
"LicenseNumber": "834615",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}