Individual
MATTHEW S LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
17C BRENTSHIRE SQUARE, JACKSON, TN 38305-2273
(731) 664-1717
(731) 664-7114
Mailing address
17C BRENTSHIRE SQUARE, JACKSON, TN 38305-2273
(731) 664-1717
(731) 664-7114
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN0000057803
TN
163W00000X
Registered Nurse
RN0000067803
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APN0000009329
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521318
—
TN
05
—
3607376
—
TN
Enumeration date
08/17/2005
Last updated
05/21/2020
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