Provider Demographics
NPI:1467957860
Name:LONG, SARAH ROSE (AGACNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:LONG
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ROSE
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 N WALDRON ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1197
Mailing Address - Country:US
Mailing Address - Phone:620-669-2500
Mailing Address - Fax:620-694-2062
Practice Address - Street 1:2101 N WALDRON ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1197
Practice Address - Country:US
Practice Address - Phone:620-694-4194
Practice Address - Fax:620-694-2128
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78102-102363LA2200X, 363LA2100X
KS5378102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care