Provider Demographics
NPI:1437345204
Name:LONG, CHRISTINE L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:L
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-998-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:6204 BALCONES DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4214
Practice Address - Country:US
Practice Address - Phone:512-427-9400
Practice Address - Fax:512-342-2723
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX835115363L00000X
GARN135873363L00000X
TXAP123805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323945101Medicaid
TXP01843064OtherRAILROAD
GA428863658AMedicaid
TX299755YTU3Medicare PIN
TX323945101Medicaid