Provider Demographics
NPI:1275336612
Name:LONG, SHARON KAY
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:LONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 RIKE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-3935
Mailing Address - Country:US
Mailing Address - Phone:870-534-2035
Mailing Address - Fax:870-534-2058
Practice Address - Street 1:2410 RIKE DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-3935
Practice Address - Country:US
Practice Address - Phone:870-534-2035
Practice Address - Fax:870-534-2058
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR043278163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse