Provider Demographics
NPI:1609322841
Name:LONG, DEBBIE (RN)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SPENCER COUNTY HEALTH DEPARTMENT 88 SPEARS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071
Mailing Address - Country:US
Mailing Address - Phone:502-477-8146
Mailing Address - Fax:502-477-5624
Practice Address - Street 1:88 SPEARS DRIVE
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071
Practice Address - Country:US
Practice Address - Phone:502-477-8146
Practice Address - Fax:502-477-5624
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1060968163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1060968OtherKY NURSES LICENSE NUMBER