Debra Larae Long, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

201305 Issued in NC

Practice address

111 Gateway Center Dr
Kernersville, NC 27284-2999

Phone

(336) 996-2173

Fax

(336) 996-3254

NPI assigned

Aug 12, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1508058728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-996-2173",
            "fax_number": "336-996-3254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GATEWAY CENTER DR",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842999",
            "telephone_number": "336-996-2173",
            "fax_number": "336-996-3254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "DEBRA",
        "middle_name": "LARAE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-12",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "091405",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "201305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrienne Lynn Loffredo, LCMHCA
• Ann Logan, RPH
• Nicole Ayssa Lollis, LCMHC
• Tara Denise Lone, LMBT
• Ashley Long
• Kaia Look
• Matthew Lopatka
• Angela Marie Lopez, LPTA
• Kashia Lor
• Mallory McCormack Loser, NP

• All providers in Kernersville, NC
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.