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Individual

MISS KATHY AMANDA LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP-BC

Contact information

Practice address
108 AIRWAY DR, MARION, IL 62959-5841
(618) 997-7820
(618) 997-6721
Mailing address
2831 LONE OAK RD, PADUCAH, KY 42003-8041
(270) 554-8373
(270) 554-8987

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3092927
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
78905296
KY
Enumeration date
11/15/2006
Last updated
02/19/2020
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