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General NPI Number Information
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NPI Number | 1588256150
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Entity Type | Individual
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Provider Name | KATHERINE LONG
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Gender | Female
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Dates
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Enumeration Date | 02/05/2021
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 5550 WARREN PKWY STE 200
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City | FRISCO
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State | TX
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Zip | 75034-7399
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Country | US
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Telephone | 217-493-1377
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Fax |
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Provider Business Mailing Address
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Address Line | 5250 TOWN AND COUNTRY BLVD APT 5303
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City | FRISCO
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State | TX
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Zip | 75034-6980
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Country | US
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Telephone | 217-493-1377
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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 | PA17632
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.008165
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License Number State | IL
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