Individual
NICHOLAS LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED, ATC, LAT
Contact information
Practice address
1600 WASHINGTON AVE, CONWAY, AR 72032-4115
(501) 450-5045
Mailing address
1600 WASHINGTON AVE, CONWAY, AR 72032-4115
(501) 450-5045
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT 611
AR
Other
Enumeration date
08/04/2014
Last updated
08/04/2014
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