Provider Demographics
NPI:1871808303
Name:LONG, KELLY A (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:508 W VANDAMENT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4665
Mailing Address - Country:US
Mailing Address - Phone:405-350-8100
Mailing Address - Fax:405-350-3744
Practice Address - Street 1:2130 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7025
Practice Address - Country:US
Practice Address - Phone:403-303-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2025-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK48313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily