Provider Demographics
NPI:1508668450
Name:LONG, BRANDY (BS, LPN)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:LONG
Suffix:
Gender:
Credentials:BS, LPN
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5500 MING AVE STE 265
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4696
Mailing Address - Country:US
Mailing Address - Phone:816-263-1001
Mailing Address - Fax:816-652-9356
Practice Address - Street 1:3205 N TWYMAN RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-3212
Practice Address - Country:US
Practice Address - Phone:816-263-1001
Practice Address - Fax:816-652-9356
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999135729164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1999135729OtherLICENSE