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NPI Code Detail

MEDICARE: KRISTEN LONGINO NP-C

MEDICARE: KRISTEN LONGINO NP-C
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 Practitioner3010115KY

General Provider Information

NPI Number : 1396104550
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN LONGINO NP-C
Provider Business Mailing Address
First Line : 3903 VANTAGE PL
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-6801
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3903 VANTAGE PL
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-6801
Country : US
Telephone Number : 502-657-1076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2016
Last Update Date : 02/16/2016

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Directions to “ KRISTEN LONGINO NP-C” Practice Location

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