Long, Amanda Nicole

Long, Amanda Nicole is an individual health care provider with primary practice located at 619 S Fleishel Ave Ste 327, Tyler TX 75701-2004. She recently has only one registered license in Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, which is considered as her primary health care specialty. Long, Amanda Nicole can be contacted via phone (903) 510-1173.

Contact Information

Primary practice address
619 S Fleishel Ave Ste 327 Tyler TX 75701-2004
Phone: (903) 510-1173
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X P2894 Texas

Profile Details

NPI number 1013129931
LBN Legal business name Long, Amanda Nicole
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2007
Last updated Feb 9th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013129931 NPPES
Texas MEDICAID 302066101
Texas Other 752616977012
Texas Other 8DF550

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