# MICHELLE DAWN LONG

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

## Provider details

- **NPI number:** 1699976431
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 1092014 | KY | — |
| 363L00000X | Nurse Practitioner | 3005068 | KY | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | 3005068 | KY | — |

## Other

- **Enumeration date:** 05/30/2007
- **Last updated:** 10/29/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2852506 | — | OH |
| 05 | — | 7100041660 | — | KY |