Provider Demographics
NPI:1295376945
Name:LONG, AMANDA KATE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATE
Last Name:LONG
Suffix:
Gender:
Credentials:PMHNP-BC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3939 W WINDMILLS BLVD APT 1120
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1359
Mailing Address - Country:US
Mailing Address - Phone:602-518-0232
Mailing Address - Fax:602-610-2555
Practice Address - Street 1:3555 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7610
Practice Address - Country:US
Practice Address - Phone:353-747-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31845363LP0808X
TXAP143361363LP0808X
AZ251491363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty