Long, Kathy Amanda

Long, Kathy Amanda is an individual health care provider with primary practice located at 108 Airway Dr , Marion IL 62959-5841. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Long, Kathy Amanda can be contacted via phone (618) 997-7820.

Contact Information

Primary practice address
108 Airway Dr Marion IL 62959-5841
Phone: (618) 997-7820
Fax: (618) 997-6721
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 3092927 Kentucky

Profile Details

NPI number 1407929870
LBN Legal business name Long, Kathy Amanda
Credentials ARNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2006
Last updated Feb 19th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407929870 NPPES
Kentucky MEDICAID 78905296

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