Long, Kathleen A
Long, Kathleen A is an individual health care provider with primary practice located at 420 W 4Th St , Mishawaka IN 46544-1948. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Long, Kathleen A can be contacted via phone (574) 307-7673.Contact Information
Primary practice address
420 W 4Th St
Mishawaka IN 46544-1948
Phone: (574) 307-7673
Fax: (574) 307-7692
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 71001562A | Indiana |
Profile Details
| NPI number | 1831113026 |
|---|---|
| LBN Legal business name | Long, Kathleen A |
| Credentials | APRN-BC, ND |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 27th, 2006 |
| Last updated | Jan 17th, 2019 - about 5 years ago |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831113026 | NPPES |
| Indiana | MEDICAID | 200441170 | |
| Indiana | Other | 000000878026 |
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