Provider Demographics
NPI:1265559645
Name:LONGLEY, DAVID SEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SEAN
Last Name:LONGLEY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 312
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834
Mailing Address - Country:US
Mailing Address - Phone:325-625-3533
Mailing Address - Fax:325-625-3477
Practice Address - Street 1:310 S PECOS ST FL 2
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-4159
Practice Address - Country:US
Practice Address - Phone:325-625-3533
Practice Address - Fax:325-625-3477
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX683182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673827Medicare Oscar/Certification