Individual provider Active NPI

Kayla Long, FNP

  • Family Nurse Practitioner
  • Sullivan, MO
National Provider Identifier
1689491086
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
INPROCESS Issued in MO
Practice address
1326 S Service Rd W Ste 10
Sullivan, MO 63080-2306
Phone
(573) 468-4455
NPI assigned
Sep 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X INPROCESS MO Primary

Addresses

Primary practice location

1326 S Service Rd W Ste 10
Sullivan, MO 63080-2306

Mailing address

192 Ole Dirt Rd
Bourbon, MO 65441-8231
Phone (314) 402-8408

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241105003696 MO Practitioner - Nurse Practitioner 3971037524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

1326 S Service W Rd
Suite 10
Sullivan, MO 63080-2306
Phone (573) 468-4455

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
INPROCESSMOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities Family CurrentSince Nov 10, 2024 Accepting new patients
Mercy Clinic East Communities CurrentSince Nov 10, 2024 Accepting new patients

Locations

1326 S Service Rd W
Ste 10
Sullivan, MO 63080
Phone (573) 468-4455

1326 S Service Rd W
#10
Sullivan, MO 63080
Phone (573) 468-4455

851 E 5th St
Ste 316
Washington, MO 63090
Phone (636) 239-7559

851 E 5th St
Ste 328
Washington, MO 63090
Phone (636) 239-1101

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1727222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1689491086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "192 OLE DIRT RD",
            "city": "BOURBON",
            "state": "MO",
            "postal_code": "654418231",
            "telephone_number": "314-402-8408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1326 S SERVICE RD W STE 10",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802306",
            "telephone_number": "573-468-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "KAYLA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-25",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "INPROCESS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sullivan, MO

Sources for this page

Verify at the official NPI Registry.