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General NPI Number Information
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NPI Number | 1689491086
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Entity Type | Individual
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Provider Name | KAYLA LONG FNP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1326 S SERVICE RD W STE 10
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City | SULLIVAN
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State | MO
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Zip | 63080-2306
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Country | US
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Telephone | 573-468-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 192 OLE DIRT RD
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City | BOURBON
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State | MO
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Zip | 65441-8231
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Country | US
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Telephone | 314-402-8408
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | INPROCESS
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License Number State | MO
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