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General NPI Number Information
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NPI Number | 1609185859
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Entity Type | Individual
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Provider Name | ASHLEY LONG FNP
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Gender | Female
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 589 GARFIELD ST SUITE 201
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City | TUPELO
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State | MS
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Zip | 38801-6301
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Country | US
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Telephone | 662-680-5565
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Fax | 662-680-5654
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Provider Business Mailing Address
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Address Line | ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
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City | GERMANTOWN
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State | TN
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Zip | 38183-0021
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Country | US
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Telephone | 662-680-5565
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Fax | 662-680-5654
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R869971
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License Number State | MS
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