Individual
KAYLA LYNNE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
11012 E 13 MILE RD STE 112, WARREN, MI 48093-2546
(586) 582-0760
Mailing address
4466 W BRISTOL RD, FLINT, MI 48507-3170
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010456
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06376
BCBSM
—
05
—
381958736
—
MI
Enumeration date
02/26/2021
Last updated
04/06/2026
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