Provider Demographics
NPI:1912538273
Name:LONG, HANNAH KALYN (CRNP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:KALYN
Last Name:LONG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11124 AL HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-5135
Mailing Address - Country:US
Mailing Address - Phone:256-522-8289
Mailing Address - Fax:
Practice Address - Street 1:2424 DANVILLE RD SW STE K
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4219
Practice Address - Country:US
Practice Address - Phone:256-309-5850
Practice Address - Fax:256-350-5851
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily