MEDICARE: JENNIFER LEEANN LONG APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ATP-000303	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013223130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEEANN LONG APN

Provider Business Mailing Address
First Line	:	117 S 2ND ST
Second Line	:	PO BOX 497
City	:	AUGUSTA
State	:	AR
Zip	:	72006-2309
Country	:	US
Telephone Number	:	870-347-2534
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 HIGHWAY 18
Second Line	:
City	:	LAKE CITY
State	:	AR
Zip	:	72437-9622
Country	:	US
Telephone Number	:	870-237-9928
Fax Number	:	870-237-1012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	01/21/2026

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