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General NPI Number Information
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NPI Number | 1447587027
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Entity Type | Individual
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Provider Name | JUSTIN ALLEN LONG PA
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Gender | Male
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 501 S SANTA FE AVE, SUITE 200
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City | SALINA
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State | KS
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Zip | 67401
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Country | US
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Telephone | 785-452-7562
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Fax | 785-452-7105
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Provider Business Mailing Address
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Address Line | 501 S SANTA FE AVE, SUITE 200
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City | SALINA
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State | KS
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Zip | 67401
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Country | US
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Telephone | 785-452-7562
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Fax | 785-452-7105
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 15-02009
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA150409
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1502009
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License Number State | KS
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