Organization
LONGEVITY MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE D LONG DNP,FNP-BC,PMHNP-BC (OWNER)
(901) 440-6045
Entity
Organization
Contact information
Practice address
1355 B LYNNFIELD RD, STE 205, MEMPHIS, TN 38119-5801
(901) 440-6045
(901) 459-3373
Mailing address
PO BOX 4355, CORDOVA, TN 38088-4355
(901) 440-6045
(901) 459-3373
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
APN14184
TN
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
APN14184
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1527059
—
TN
Enumeration date
01/23/2012
Last updated
03/11/2021
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