# LONGEVITY MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467723486
- **Authorized official:** VICKIE D LONG DNP,FNP-BC,PMHNP-BC (OWNER)
- **Authorized official phone:** (901) 440-6045

## Contact information

- **Practice address:** 1355 B LYNNFIELD RD, STE 205, MEMPHIS, TN 38119-5801
- **Practice address phone:** (901) 440-6045
- **Practice address fax:** (901) 459-3373
- **Mailing address:** PO BOX 4355, CORDOVA, TN 38088-4355
- **Mailing address phone:** (901) 440-6045
- **Mailing address fax:** (901) 459-3373

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WG0600X | Gerontology Registered Nurse | APN14184 | TN | — |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | APN14184 | TN | Yes |

## Other

- **Enumeration date:** 01/23/2012
- **Last updated:** 03/11/2021