Provider Demographics
NPI:1952950859
Name:LONG, MEGAN D (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:D
Last Name:LONG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 SOSSOMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-8751
Mailing Address - Country:US
Mailing Address - Phone:704-305-7343
Mailing Address - Fax:
Practice Address - Street 1:2511 OLD CORNWALLIS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1869
Practice Address - Country:US
Practice Address - Phone:844-932-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily