Provider Demographics
NPI:1912302159
Name:LONG, YOLANDA PATRICE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:PATRICE
Last Name:LONG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BROAD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2416
Mailing Address - Country:US
Mailing Address - Phone:544-414-2072
Mailing Address - Fax:
Practice Address - Street 1:3702 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39563-6218
Practice Address - Country:US
Practice Address - Phone:228-205-4592
Practice Address - Fax:228-205-4593
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS905597363LP2300X
AL1-099664363LF0000X
MSR866997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse