Individual
KATHLEEN ADELE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
COA.04325-NP
OH
363LG0600X
Gerontology Nurse Practitioner
NP-04325
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0132593
—
OH
05
—
3810029099
—
WV
Enumeration date
01/26/2006
Last updated
07/27/2016
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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