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General NPI Number Information
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NPI Number | 1275127540
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Entity Type | Individual
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Provider Name | KAYLA LYNNE LONG PA
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Gender | Female
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 11012 E 13 MILE RD STE 112
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City | WARREN
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State | MI
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Zip | 48093-2546
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Country | US
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Telephone | 586-582-0760
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Fax |
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Provider Business Mailing Address
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Address Line | 4466 W BRISTOL RD
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City | FLINT
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State | MI
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Zip | 48507-3170
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601010456
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License Number State | MI
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