Provider Demographics
NPI:1659199289
Name:LONG, KAYLEE JO
Entity type:Individual
Prefix:
First Name:KAYLEE JO
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 LINWOOD DR STE B1707
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5364
Mailing Address - Country:US
Mailing Address - Phone:870-604-4455
Mailing Address - Fax:
Practice Address - Street 1:1707 LINWOOD DR STE B1707
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5364
Practice Address - Country:US
Practice Address - Phone:870-604-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator