Provider Demographics
NPI:1093310344
Name:PREMIER PLUS PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:PREMIER PLUS PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, CPNP-PC
Authorized Official - Phone:830-491-5019
Mailing Address - Street 1:932 S HIGHWAY 123 BYP
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-9756
Mailing Address - Country:US
Mailing Address - Phone:830-491-5019
Mailing Address - Fax:
Practice Address - Street 1:932 S ST HWY 123 BYP
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-9756
Practice Address - Country:US
Practice Address - Phone:830-609-8270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty