Provider Demographics
NPI:1548577885
Name:LONG, TERESA KAY (RN, BSN, COHN-S)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:KAY
Last Name:LONG
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Gender:F
Credentials:RN, BSN, COHN-S
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Mailing Address - Street 1:126 MISSOURI AVE
Mailing Address - Street 2:OCCUPATIONAL HEALTH BOX 1227
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-8952
Mailing Address - Country:US
Mailing Address - Phone:573-329-1993
Mailing Address - Fax:573-329-8521
Practice Address - Street 1:197 REPLACEMENT AVE
Practice Address - Street 2:SUITE 139
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-9089
Practice Address - Country:US
Practice Address - Phone:573-329-1933
Practice Address - Fax:573-329-8521
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
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Provider Licenses
StateLicense IDTaxonomies
MO103766163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health