Individual
DONICA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
400 NORTHWEST PLZ, SENATOBIA, MS 38668-1740
(662) 301-8330
(662) 301-8374
Mailing address
986 ANTIOCH RD, COLDWATER, MS 38618-8165
(662) 209-2008
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902328
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MS
Enumeration date
10/17/2017
Last updated
08/21/2024
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