RANDY J. LONG (NPI# 1366520686) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366520686 |
| Entity Type | Individual |
| Full Name | RANDY J. LONG |
| Credential | PA-C, FAPACUS |
| Practice Address |
9350 E. 35th Street North Suite 104 Wichita KS 67226 |
| Practice Telephone | 3166166272 |
| Practice Fax Number | 3168587085 |
| Mailing Telephone | 3166166272 |
| Mailing Fax Number | 3166160407 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2010-01-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 15-00793 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 1500793 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 2004260304 | 05 | |
| KS | BLUE CROSS BLUE SHIELD | 426953 | 01 |
| KS | 100402610B | 05 |
| Street Address |
9350 E. 35TH STREET NORTH SUITE 104 |
| City | WICHITA |
| State | KS |
| Zip Code | 67226 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386111649 | Kansas Diabetes and Endocrinology Center LLC | Clinic/Center | 3161 N Webb Rd, Suite 200, Wichita, KS 67226 | 2018-10-25 |
| 1619474020 | Village Dentistry, Pa | Dentist | 2222 N. Greenwich, Suite 400, Wichita, KS 67226 | 2018-04-11 |
| 1861910408 | Lindsay Beth Kachelmeier | Marriage & Family Therapist | 6525 E Mainsgate, Wichita, KS 67226 | 2017-09-04 |
| 1659800084 | Doris Kimbrell | Clinical Nurse Specialist | 8200 East Thorn, Wichita, KS 67226 | 2017-06-08 |
| 1467986836 | Megan Elizabeth Couey | Counselor | 8623 E 32nd St. N, Suite 100, Wichita, KS 67226 | 2017-04-12 |
| 1306298922 | Wilson Yip | Dentist | 2222 N Greenwich Rd, Wichita, KS 67226 | 2016-07-07 |
| 1396102315 | Healthy Balance Center, LLC | Marriage & Family Therapist | 8100 E 22nd St. North, #1800-2, Wichita, KS 67226 | 2016-01-21 |
| 1851775142 | Cardiac Cath Lab of Wichita Lp | Clinic/Center | 3555 North Webb Rd., Suite A, Wichita, KS 67226 | 2015-07-16 |
| 1114334067 | Jane Crawford | Nurse Practitioner | 8623 E 32nd St N, Wichita, KS 67226 | 2014-07-11 |
| 1801202882 | Erin Kellie Jeffress | Occupational Therapy Assistant | 3500 N Rock Rd, Building 2200, Ste 101, Wichita, KS 67226 | 2014-07-10 |
| Find all providers in zip 67226 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871116582 | Alia Porter | Physician Assistant | 115 N Terrace Dr, Wichita, KS 67208-3941 | 2020-05-28 |
| 1881217594 | Taylor Nicole Wondra | Physician Assistant | 1845 N Woodrow Ct, Wichita, KS 67203-2959 | 2020-05-28 |
| 1497378087 | Haley Nicole Northcutt | Physician Assistant | 10107 W Jamesburg St, Wichita, KS 67212-6743 | 2020-05-18 |
| 1649892357 | Mong Trinh Thi Hoang | Physician Assistant | 1933 N Wellington Pl, Wichita, KS 67203-2558 | 2020-05-15 |
| 1609434000 | Branden Tang | Physician Assistant | 10112 E Clark St, Wichita, KS 67207-7747 | 2019-05-31 |
| 1184093379 | Evan C Ohlman | Physician Assistant | 3009 N Cypress, Wichita, KS 67226-4003 | 2015-09-18 |
| 1629388079 | Sara A Hildreth | Physician Assistant | 9415 E Harry St Ste 202, Wichita, KS 67207-5076 | 2010-10-19 |
| 1477700235 | Heather S Bloomer | Physician Assistant | 2465 N Woodridge Ct, Wichita, KS 67226-8208 | 2008-08-25 |
| 1205030145 | William Paul Wondra | Physician Assistant | 141 W Elm St, Sedgwick County Detention Facility, Wichita, KS 67203-3848 | 2007-06-13 |
| 1194888602 | Vicki L Gromala | Physician Assistant | 1861 N. Road Road, Suite 105, Wichita, KS 67206-1264 | 2006-12-18 |
| Find all providers in WICHITA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.