Individual
DEBRA LARAE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
111 GATEWAY CENTER DR, KERNERSVILLE, NC 27284-2999
(336) 996-2173
(336) 996-3254
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 996-2173
(336) 996-3254
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
201305
NC
363LF0000X
Family Nurse Practitioner
091405
NC
Other
Enumeration date
08/12/2007
Last updated
07/23/2013
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