Mikayla Sue Long

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA60560891 Issued in WA

Practice address

17432 Smokey Point Blvd Ste 105
Arlington, WA 98223-8784

Phone

(360) 653-2222

Fax

(360) 653-5730

NPI assigned

Jul 14, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mikayla Sue Long Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442188800000",
    "number": "1811371404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17432 SMOKEY POINT BLVD STE 105",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982238784",
            "telephone_number": "360-653-2222",
            "fax_number": "360-653-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17432 SMOKEY POINT BLVD STE 105",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982238784",
            "telephone_number": "360-653-2222",
            "fax_number": "360-653-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "MIKAYLA",
        "middle_name": "SUE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-14",
        "last_updated": "2015-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA60560891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIKAYLA",
            "last_name": "LONG",
            "middle_name": "SUE",
            "credential": "LMP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Specialist in Arlington, WA
• Providers in Arlington, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2015; 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.