Active NPI
Darian Wade Long I
- Peer Specialist
- Kennett, MO
National Provider Identifier
1912303405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 8162
- Practice address
- 925 Highway VV
Kennett, MO 63857 - Phone
- (573) 888-5925
- Fax
- (573) 888-9365
- NPI assigned
- Nov 10, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 8162 | MO | Primary |
Addresses
Primary practice location
925 Highway VV
Kennett, MO 63857
Mailing address
925 Highway VV
Kennett, MO 63857-0071
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8162 | MO | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Counseling Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Primary Care Clinic/Center
- Poplar Bluff, MO
- NPI 1235738493
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415577600000",
"number": "1912303405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 HIGHWAY VV",
"city": "KENNETT",
"state": "MO",
"postal_code": "638570071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 HIGHWAY VV",
"city": "KENNETT",
"state": "MO",
"postal_code": "63857",
"telephone_number": "573-888-5925",
"fax_number": "573-888-9365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "DARIAN",
"middle_name": "WADE",
"name_prefix": "Mr.",
"name_suffix": "I",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-11-10",
"last_updated": "2014-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "MO",
"license": "8162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennett, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.