Individual
CHALLIS MADISON LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5615 DEAUVILLE STE 240, MIDLAND, TX 79706-2709
(432) 221-5560
Mailing address
5615 DEAUVILLE STE 240, MIDLAND, TX 79706-2709
(432) 221-5560
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP139265
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP139265
STATE LICENSE
TX
Enumeration date
11/27/2018
Last updated
09/08/2020
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