Individual
MS. KELLY PATRICIA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CPNP
Contact information
Practice address
900 E 13TH ST, SUITE 101, GROVE, OK 74344-2975
(918) 786-9900
(918) 786-9904
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(918) 786-9900
(918) 786-9904
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
61374
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200311440A
—
OK
05
—
200505990H
—
OK
Enumeration date
11/16/2010
Last updated
04/05/2017
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