MEDICARE: ALAINA JOY LONG

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	163W00000X	Registered Nurse	1025961	TX

General Provider Information

NPI Number	:	1518558345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAINA JOY LONG

Provider Business Mailing Address
First Line	:	8213 DOWNE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-3005
Country	:	US
Telephone Number	:	817-480-4246
Fax Number	:

Provider Business Practice Location Address
First Line	:	8213 DOWNE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-3005
Country	:	US
Telephone Number	:	817-480-4246
Fax Number	:

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

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	02/03/2021

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