Individual
KYLE DAVID LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
825 FAIRFAX AVE UNIT 310, NORFOLK, VA 23507-1914
(757) 238-4497
Mailing address
4701 LAKE SHORE DR, CHESAPEAKE, VA 23321-1383
(757) 803-4806
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110006758
VA
363A00000X
Physician Assistant
0110006768
VA
Other
Enumeration date
03/28/2019
Last updated
06/14/2022
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