Provider Demographics
NPI:1912270265
Name:LONG, LORI EVE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:EVE
Last Name:LONG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 N LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4455
Mailing Address - Country:US
Mailing Address - Phone:931-762-7471
Mailing Address - Fax:931-762-3121
Practice Address - Street 1:2131 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4455
Practice Address - Country:US
Practice Address - Phone:931-762-7471
Practice Address - Fax:931-762-3121
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily