Provider Demographics
NPI:1376128132
Name:DELONG, GARRETT BRADLEY (APRN)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:BRADLEY
Last Name:DELONG
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1815
Mailing Address - Country:US
Mailing Address - Phone:785-301-1537
Mailing Address - Fax:785-203-8439
Practice Address - Street 1:1260 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1815
Practice Address - Country:US
Practice Address - Phone:785-301-1537
Practice Address - Fax:785-203-8439
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80073-091363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health