Provider Demographics
NPI:1194292649
Name:LONG, MELINDA (APRN)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 HIGH ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-6300
Mailing Address - Country:US
Mailing Address - Phone:270-887-0270
Mailing Address - Fax:270-886-3969
Practice Address - Street 1:10755 EAGLE WAY STE 100
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8742
Practice Address - Country:US
Practice Address - Phone:270-887-0270
Practice Address - Fax:270-886-3969
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3012848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily