Individual
TESSA LYNN LONGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
900 E 13TH ST, SUITE 205, GROVE, OK 74344-2975
(918) 786-2720
(918) 786-8020
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(918) 786-2720
(918) 786-8020
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
83227
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200468380X
—
OK
05
—
200504950A
—
OK
Enumeration date
07/25/2013
Last updated
04/05/2017
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