KELLY LYNN LONG (NPI# 1568623338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568623338 |
| Entity Type | Individual |
| Full Name | KELLY LYNN LONG |
| Credential | PA-C |
| Practice Address |
10909 Hannan Rd Romulus MI 48174-1383 |
| Practice Telephone | 7348931056 |
| Practice Fax Number | 7349417522 |
| Mailing Telephone | 7348931056 |
| Mailing Fax Number | 7349417522 |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2016-07-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601003518 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MICHIGAN LICENSE | 5601003518 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013551894 | Kelly Denise Long | Physical Therapist | 6410 Diamond Rock Dr, Katy, TX 77449-4241 | 2019-11-04 |
| 1316319148 | Kelly Long | Occupational Therapist | 1906 Kenwood Ave, Charlotte, NC 28205-3646 | 2015-10-20 |
| 1013189703 | Kelly Elizabeth Long | Counselor | 115 W 5th, Emporia, KS 66801 | 2008-04-02 |
| 1720649676 | Kelly Long | Licensed Vocational Nurse | 2180 Valley Blvd, Pomona, CA 91768-3325 | 2019-06-21 |
| 1366949539 | Kelly Mckinley Long | Student in an Organized Health Care Education/Training Program | 477 Cooper Rd Ste 300, Westerville, OH 43081-8057 | 2018-04-12 |
| 1447551817 | Kelly Patricia Long | Nurse Practitioner | 900 E 13th St, Suite 101, Grove, OK 74344-2975 | 2010-11-16 |
| 1871808303 | Kelly A Long | Nurse Practitioner | 1025 Straka Ter, Oklahoma City, OK 73139-2544 | 2010-08-09 |
| 1447408133 | Kelly Long | Counselor | 615 Shipyard Blvd, Wilmington, NC 28412 | 2008-09-05 |
| 1457564726 | Kelly Long | Counselor | 15303 St. Rt 170, East Liverpool, OH 43920-9216 | 2007-05-07 |
| 1457438905 | Kelly Ann Long | Audiologist | 15 Exchange Dr, Lugoff, SC 29078-9198 | 2006-11-01 |
| Street Address |
10909 HANNAN RD |
| City | ROMULUS |
| State | MI |
| Zip Code | 48174-1383 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295773281 | Special Tree Rehabilitation Services Ltd | Clinic/Center | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2006-06-03 |
| 1649877986 | Special Tree Rehabilitation Services Ltd | Residential Treatment Facility, Physical Disabilities | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2020-10-08 |
| 1306443742 | Special Tree Neuro Care Center | Clinic/Center | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2020-10-08 |
| 1922655869 | Emilie Herpick | Recreation Therapist | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2019-08-26 |
| 1740837681 | Kristin Overweg Claerhout | Recreation Therapist | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2019-08-26 |
| 1629517701 | Special Tree Laboratory Service, LLC | Clinical Medical Laboratory | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2017-02-22 |
| 1639620024 | Jessica Hurlston | Psychologist | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2016-10-20 |
| 1346695202 | Southeast Michigan Physicians Group | Specialist | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2016-04-28 |
| 1851790414 | Denise Farris | Technician, Pathology | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2014-08-20 |
| 1114330263 | Ursula Kotzabassi | Occupational Therapist | 10909 Hannan Rd, Romulus, MI 48174-1383 | 2014-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417447947 | Pamela Ann Kaczor | Nurse Practitioner | 28721 Northline Rd, Romulus, MI 48174 | 2018-05-10 |
| 1750806469 | Demetrius Kirk | Registered Nurse | 30075 Spain, Romulus, MI 48174 | 2017-08-03 |
| 1982133302 | Tamika Lloyd | Non-emergency Medical Transport (VAN) | 6002 Bay Hill Ct, Romulus, MI 48174 | 2017-06-08 |
| 1811346422 | Maxine Vernette Hawk | Nurse Practitioner | 39061 Commons Dr., Romulus, MI 48174 | 2016-06-06 |
| 1164880282 | Lacara Gilmore | Counselor | 15056 Colbert St, 03, Romulus, MI 48174 | 2016-02-03 |
| 1982082632 | Kristin Michelle Rhan | Licensed Practical Nurse | 10195 Diane St. Apt302, Romulus, MI 48174 | 2015-05-14 |
| 1790176790 | Dylan Marie Feil | Social Worker | 37300 Wick Rd, Romulus, MI 48174 | 2015-02-11 |
| 1285053710 | Janeise Daniels | Licensed Practical Nurse | 9426 Lisa, Romulus, MI 48174 | 2014-04-14 |
| 1699119461 | James A. Lee | Counselor | C/o Reliance Counseling, LLC, 11126 Wayne Rd., Romulus, MI 48174 | 2013-04-24 |
| 1922302132 | Covenant To Care, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 37292 Mcbride, Romulus, MI 48174 | 2011-01-03 |
| Find all providers in zip 48174 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316064124 | Stephen John Kingston II | Physician Assistant | Route 96, Romulus, NY 14541-0400 | 2007-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616687 | Alexandria Jaclyn Miller | Physician Assistant | 4700 Chipman Dr, Waterford, MI 48327-3413 | 2020-10-15 |
| 1639777287 | Piotr Z Purzycki | Physician Assistant | 41400 Dequindre Rd Ste 101, Sterling Heights, MI 48314-3751 | 2020-10-15 |
| 1013524859 | Amber Marie Lee | Physician Assistant | 2265 South Lindenroad, Suite A, Flint, MI 48532 | 2020-09-25 |
| 1326656844 | Dominic Farrell | Physician Assistant | 224 Portchester Rd, Holland, MI 49424-2628 | 2020-07-21 |
| 1982212072 | Alexandria Bower-nelson | Physician Assistant | 1302 Porter Drive, Charlotte, MI 48813 | 2020-07-15 |
| 1013535343 | Maria Pavia | Physician Assistant | 41302 Scarborough Ln, Novi, MI 48375-2893 | 2020-07-13 |
| 1073130241 | Kelly F Esper | Physician Assistant | 9043 Glenwood Ln, Northville, MI 48168-9129 | 2020-07-02 |
| 1811513971 | Tasha Baker | Physician Assistant | 5444 E Whitefeather Rd, Pinconning, MI 48650-8407 | 2020-06-24 |
| 1437770054 | Sterling Ryan Maxfield | Physician Assistant | 6187 Oak Grove Rd, Howell, MI 48855-8247 | 2020-05-05 |
| 1760018808 | Rachel Renee Mackmin | Physician Assistant | 41498 Mary Kay Dr, Clinton Township, MI 48038-1989 | 2020-03-20 |
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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.