Provider Demographics
NPI:1073247409
Name:LONGEST, ALLISON MARIE (MSN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:LONGEST
Suffix:
Gender:F
Credentials:MSN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13710 ST FRANCIS BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3267
Mailing Address - Country:US
Mailing Address - Phone:804-794-6400
Mailing Address - Fax:804-897-0910
Practice Address - Street 1:13700 ST FRANCIS BLVD STE 600
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3223
Practice Address - Country:US
Practice Address - Phone:804-794-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184677363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024184677OtherVA LICENSE
2022012497OtherANCC