Provider Demographics
NPI:1053120329
Name:LONG, GRACE TAYLOR (PA)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:TAYLOR
Last Name:LONG
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3336 N FUTRALL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4057
Mailing Address - Country:US
Mailing Address - Phone:479-463-3000
Mailing Address - Fax:479-463-3050
Practice Address - Street 1:3336 N FUTRALL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4057
Practice Address - Country:US
Practice Address - Phone:479-463-3000
Practice Address - Fax:479-463-3050
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AR363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant