Provider Demographics
NPI:1417444753
Name:LONG, AMANDA BRENDLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BRENDLE
Last Name:LONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 ASTER LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30560-3256
Mailing Address - Country:US
Mailing Address - Phone:828-557-5715
Mailing Address - Fax:
Practice Address - Street 1:857 ASTER LN
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:GA
Practice Address - Zip Code:30560-3256
Practice Address - Country:US
Practice Address - Phone:828-557-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN179445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily