Provider Demographics
NPI:1205997210
Name:LONG, ABIGAIL MAE (APRN)
Entity type:Individual
Prefix:MISS
First Name:ABIGAIL
Middle Name:MAE
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 1:4700 FORUM BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5654
Mailing Address - Country:US
Mailing Address - Phone:573-449-4936
Mailing Address - Fax:573-449-6795
Practice Address - Street 1:103 RIPLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5738
Practice Address - Country:US
Practice Address - Phone:573-442-9944
Practice Address - Fax:573-442-5345
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003005274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily