Provider Demographics
NPI:1619152600
Name:LONG, JAIME C (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:C
Last Name:LONG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7600
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417-0600
Mailing Address - Country:US
Mailing Address - Phone:253-785-6332
Mailing Address - Fax:253-363-9219
Practice Address - Street 1:2517 N PROCTOR ST STE 1
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5337
Practice Address - Country:US
Practice Address - Phone:253-785-6332
Practice Address - Fax:253-363-9219
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60047476101YM0800X
WAAP60684467363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health