Individual
MR. KEVIN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, CEN
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
RN-88313
NM
163WE0003X
Emergency Registered Nurse
RN9359925
FL
Other
Enumeration date
02/05/2018
Last updated
02/05/2018
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