Provider Demographics
NPI:1891548012
Name:LONG, STACEY MICHELLE (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MICHELLE
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52050 STATE ROUTE 681
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45772-9751
Mailing Address - Country:US
Mailing Address - Phone:740-818-6560
Mailing Address - Fax:
Practice Address - Street 1:52050 STATE ROUTE 681
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45772-9751
Practice Address - Country:US
Practice Address - Phone:740-818-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0036164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty