Kenneth D Long

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00535 Issued in OR

Practice address

1251 NE Elm St
Prineville, OR 97754

Phone

(541) 447-1680

Fax

(541) 447-4670

NPI assigned

Aug 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• High Desert Healthcare

  • Rural Health Clinic/Center
  • Prineville, OR
  • NPI 1477554921
  NPD (past)

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

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1982605911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 NE ELM ST",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "97754",
            "telephone_number": "541-447-1680",
            "fax_number": "541-447-4670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 NE ELM ST",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "97754",
            "telephone_number": "541-447-1680",
            "fax_number": "541-447-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "KENNETH",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-01",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLEAR CHOICE",
            "identifier": "13503",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE WEST",
            "identifier": "93071013397754A001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "9700113590",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDENCE HEALTH PLANS",
            "identifier": "GRP331",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC  SOURCE",
            "identifier": "H3079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COIHS",
            "identifier": "13503",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205625",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Matthew Light, P.A.-C.
• Maddie Lindburg
• Victoria Emerald Little
• Ashley Maire Lofton, CRM
• James Howard Long, R. PH.
• Elva Lopez
• Kylie Loving
• Ashley Luna, CRM
• Rebecca G. Lundgren, RN
• Lutheran Community Service

• Physician Assistant in Prineville, OR
• Providers in Prineville, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.