Provider Demographics
NPI:1508376393
Name:LONGMIRE, JAMES LEROY II (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEROY
Last Name:LONGMIRE
Suffix:II
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-0773
Mailing Address - Country:US
Mailing Address - Phone:901-833-7095
Mailing Address - Fax:
Practice Address - Street 1:951 COURT AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2813
Practice Address - Country:US
Practice Address - Phone:901-577-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ033644Medicaid