Provider Demographics
NPI:1376823724
Name:LONG, AMY (CPNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 S ST HWY 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:830-491-5019
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:830-491-5019
Practice Address - Fax:830-491-5019
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX742708363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics