Provider Demographics
NPI:1265714315
Name:LONG, ASHLEY INABINET (ANP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:INABINET
Last Name:LONG
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:INABINET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:1301 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2942
Practice Address - Country:US
Practice Address - Phone:803-296-5914
Practice Address - Fax:803-296-5902
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17575363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1913Medicaid
SCAA78679223Medicare PIN