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General NPI Number Information
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NPI Number | 1871808303
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Entity Type | Individual
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Provider Name | KELLY A LONG NP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 2130 SW 59TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-7025
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Country | US
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Telephone | 403-303-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 508 W VANDAMENT AVE STE 100
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City | YUKON
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State | OK
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Zip | 73099-4665
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Country | US
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Telephone | 405-350-8100
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Fax | 405-350-3744
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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 | 48313
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License Number State | OK
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