Provider Demographics
NPI:1689148470
Name:LONG, STEPHANIE KATHRYNANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KATHRYNANN
Last Name:LONG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KATHRYNANN
Other - Last Name:ANGELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5246
Mailing Address - Country:US
Mailing Address - Phone:512-732-2774
Mailing Address - Fax:
Practice Address - Street 1:2025 MEMORY LN STE 400A
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-7488
Practice Address - Country:US
Practice Address - Phone:254-829-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner