Individual
KAYLA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1326 S SERVICE RD W STE 10, SULLIVAN, MO 63080-2306
(573) 468-4455
Mailing address
192 OLE DIRT RD, BOURBON, MO 65441-8231
(314) 402-8408
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
INPROCESS
MO
Other
Enumeration date
09/25/2024
Last updated
09/25/2024
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