Provider Demographics
NPI:1235895491
Name:LONG, KRYSTEL LEANN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:KRYSTEL
Middle Name:LEANN
Last Name:LONG
Suffix:
Gender:F
Credentials:PMHNP
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Mailing Address - Street 1:2151 CANDACE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-4946
Mailing Address - Country:US
Mailing Address - Phone:121-488-1898
Mailing Address - Fax:469-772-5503
Practice Address - Street 1:1301 E PARKERVILLE RD STE A8-1073
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6420
Practice Address - Country:US
Practice Address - Phone:469-222-9721
Practice Address - Fax:469-772-5503
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX834615364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult