Provider Demographics
NPI:1447551817
Name:LONG, KELLY PATRICIA (APRN, CPNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:PATRICIA
Last Name:LONG
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Gender:F
Credentials:APRN, CPNP
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-786-9900
Mailing Address - Fax:918-786-9904
Practice Address - Street 1:900 E 13TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2975
Practice Address - Country:US
Practice Address - Phone:918-786-9900
Practice Address - Fax:918-786-9904
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2017-04-05
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Provider Licenses
StateLicense IDTaxonomies
OK61374363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200311440AMedicaid
OK200505990HMedicaid