Individual
DR. AMANDA NICOLE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2026 S JACKSON ST, JACKSONVILLE, TX 75766-5822
(903) 586-5678
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
P2894
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302066101
—
TX
01
—
752616977012
TRICARE
TX
01
—
8DF550
BCBS
TX
Enumeration date
05/04/2007
Last updated
09/20/2024
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