Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 2020014418 | MO |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2020014418 | MO |
NPI | 1003414020 |
---|---|
Provider Name | Scarlett Long |
First Address | Kingsville, MO 64061-9169 |
Second Address | Kingsville, MO 64061-9169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2020 |
Last Update Date | 12/10/2020 |