Provider Demographics
NPI:1417254236
Name:LONG, VANESSA ROXANE (MSN, ARNP-BC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ROXANE
Last Name:LONG
Suffix:
Gender:F
Credentials:MSN, ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 63RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-8208
Mailing Address - Country:US
Mailing Address - Phone:405-842-4435
Mailing Address - Fax:954-851-9688
Practice Address - Street 1:100 NW 63RD ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8208
Practice Address - Country:US
Practice Address - Phone:405-842-4435
Practice Address - Fax:954-851-9688
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9312887363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEW721AMedicare Oscar/Certification