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NPI Code Detail

MEDICARE: MELINDA LONG APRN

MEDICARE:   MELINDA  LONG  APRN
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
1363LF0000XFamily Nurse Practitioner3012848KY

General Provider Information

NPI Number : 1194292649
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA LONG APRN
Provider Business Mailing Address
First Line : 1717 HIGH ST STE 2B
Second Line :
City : HOPKINSVILLE
State : KY
Zip : 42240-6300
Country : US
Telephone Number : 270-887-0270
Fax Number : 270-886-3969
Provider Business Practice Location Address
First Line : 10755 EAGLE WAY STE 100
Second Line :
City : HOPKINSVILLE
State : KY
Zip : 42240-8742
Country : US
Telephone Number : 270-887-0270
Fax Number : 270-886-3969
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2018
Last Update Date : 09/24/2020

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Directions to “ MELINDA LONG APRN” Practice Location

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