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General NPI Number Information
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NPI Number | 1295376945
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Entity Type | Individual
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Provider Name | AMANDA KATE LONG PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 16427 N SCOTTSDALE RD STE 410
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-7102
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Country | US
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Telephone | 602-800-4699
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Fax |
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Provider Business Mailing Address
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Address Line | 874 4TH ST STE D1
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3246
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Country | US
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Telephone | 415-968-6515
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Fax | 415-276-5889
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP143361
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 31845
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 251491
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95035906
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License Number State | CA
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