Provider Demographics
NPI:1316407554
Name:EUGENE, KIYAH HERLONG (CRNP)
Entity type:Individual
Prefix:
First Name:KIYAH
Middle Name:HERLONG
Last Name:EUGENE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DEANNJANAE
Other - Middle Name:NUKIYAH
Other - Last Name:HERLONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5400 KINGSMEAD DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-0240
Mailing Address - Country:US
Mailing Address - Phone:256-460-2471
Mailing Address - Fax:
Practice Address - Street 1:3500 VICTORY GROUP WAY STE 300
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9567
Practice Address - Country:US
Practice Address - Phone:972-381-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-158305163W00000X, 363L00000X
TX1191905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily