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General NPI Number Information
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NPI Number | 1912399486
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Entity Type | Individual
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Provider Name | WILLIAM LONGWORTH APRN
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Gender | Male
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Dates
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Enumeration Date | 02/20/2015
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 1250 KEENE RD STE 102
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City | NICHOLASVILLE
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State | KY
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Zip | 40356
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Country | US
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Telephone | 859-887-6752
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Fax | 859-887-6879
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Provider Business Mailing Address
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Address Line | PO BOX 936
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City | LONDON
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State | KY
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Zip | 40743-0936
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Country | US
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Telephone |
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Fax | 606-330-7825
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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 | 3009269
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 3009269
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License Number State | KY
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