NPIMap

Individual provider Active NPI

Prabha Jaishwal Long, FNP

  • Family Nurse Practitioner
  • Elizabethton, TN
National Provider Identifier
1760965628
Registry record updated Sep 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
24448 Issued in TN
Practice address
1505 W Elk Ave Ste 2
Elizabethton, TN 37643-2848
Phone
(423) 543-1261
Fax
(423) 543-7500
NPI assigned
Sep 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2018

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 24448 TN Primary

Addresses

Primary practice location

1505 W Elk Ave Ste 2
Elizabethton, TN 37643-2848

Mailing address

1505 W Elk Ave Ste 2
Elizabethton, TN 37643-2848
Phone (423) 543-1261

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181031001342 TN Practitioner - Nurse Practitioner 8729331236 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Brody School of Medicine at East Carolina University, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southeastern Physician Services PCGroup PAC ID 0042307852, 591 clinicians

Practice addresses (Care Compare)

1201 Bishop St
Union City, TN 38261-5403
Phone (731) 885-2410

1505 W Elk Ave
Suite 2
Elizabethton, TN 37643-2848
Phone (423) 543-1261

300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 302-1000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation CurrentSince Sep 1, 2018 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Sep 1, 2018 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Jan 1, 2019 Accepting new patients
Wellmont Health System Current Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Southeastern Physician Services PC CurrentSince Jul 1, 2025 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Jan 1, 2019 Accepting new patients
Blue Ridge Medical Management Corporation Family Past Accepting new patients

Locations

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

1497 W Elk Ave
Ste 21
Elizabethton, TN 37643
Phone (423) 542-7420

1505 W Elk Ave
Ste 2
Elizabethton, TN 37643
Phone (423) 543-1261

1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

1201 Bishop St
Union City, TN 38261
Phone (423) 698-6061

Interoperability endpoints

  • Direct secure messaging: plong127834@balladhealth.medalliesdirect.net

Organizations & group practices 8

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 8

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": "1536278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536278400000",
    "number": "1760965628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 W ELK AVE STE 2",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432848",
            "telephone_number": "423-543-1261",
            "fax_number": "423-543-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W ELK AVE STE 2",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432848",
            "telephone_number": "423-543-1261",
            "fax_number": "423-543-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "PRABHA",
        "middle_name": "JAISHWAL",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-07",
        "last_updated": "2018-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "24448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethton, TN

Sources for this page

Verify at the official NPI Registry.