Individual
KATHERINE MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1225 N STATE ST, SURGERY, JACKSON, MS 39202-2064
(601) 968-7047
(601) 968-4133
Mailing address
965 RIDGE LAKE BLVD STE 103, MEMPHIS, TN 38120-9446
(901) 227-3255
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
TPA0023
MS
Other
Enumeration date
03/30/2012
Last updated
03/29/2018
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