# MS. STACEY LEANNE LONG

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1417399585
- **Gender:** F
- **Credential:** PHYSICIAN ASSISTANT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA23097 | CA | — |
| 363A00000X | Physician Assistant | PA60449258 | WA | Yes |

## Other

- **Enumeration date:** 07/18/2013
- **Last updated:** 06/25/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2034728 | — | WA |
| 05 | — | 500669258 | — | OR |