Physician Compare National (NPI:1568623338)

HEALTHCARE PROVIDER: KELLY LYNN LONG PA-C

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1568623338
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527284330
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170720001137
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LONG
	Individual professional last name
Provider First Name	KELLY
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	39000 CHASE ST
	Group Practice or individual's line 1 address
City	ROMULUS
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	481741303
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y