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NPI Code Detail

MEDICARE: KELLY A LONG NP

MEDICARE: KELLY A LONG NP
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 Practitioner48313OK

General Provider Information

NPI Number : 1871808303
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY A LONG NP
Provider Business Mailing Address
First Line : 508 W VANDAMENT AVE STE 100
Second Line :
City : YUKON
State : OK
Zip : 73099-4665
Country : US
Telephone Number : 405-350-8100
Fax Number : 405-350-3744
Provider Business Practice Location Address
First Line : 2130 SW 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-7025
Country : US
Telephone Number : 403-303-7555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2010
Last Update Date : 10/16/2025

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Directions to “ KELLY A LONG NP” Practice Location

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