Provider Demographics
NPI:1902270168
Name:LONG, DONALD (FNP-C)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 COLLEGE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4667
Mailing Address - Country:US
Mailing Address - Phone:409-892-4600
Mailing Address - Fax:409-892-4605
Practice Address - Street 1:3070 COLLEGE ST STE 300
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4667
Practice Address - Country:US
Practice Address - Phone:409-892-4600
Practice Address - Fax:409-892-4605
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily