Provider Demographics
NPI:1619574662
Name:LONG, LINDSEY PAIGE (APRN)
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:PAIGE
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-9153
Mailing Address - Country:US
Mailing Address - Phone:501-247-4747
Mailing Address - Fax:
Practice Address - Street 1:3123 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-9153
Practice Address - Country:US
Practice Address - Phone:501-247-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR121152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner