LONGEVITY MEDICAL LLC NPI 1467723486

NPI Information

NPI: 1467723486
Provider Name: LONGEVITY MEDICAL LLC
Classification: Registered Nurse - 163WP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

Address:
1355 B LYNNFIELD RD
STE 205
MEMPHIS, TN
ZIP 38119
Phone: (901) 440-6045
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LONGEVITY MEDICAL LLC is a psychiatric/mental health registered nurse in Memphis, TN. LONGEVITY MEDICAL LLC NPI is 1467723486. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1355 B LYNNFIELD RD
STE 205
MEMPHIS, TN
ZIP 38119-801
Phone: (901) 440-6045
Fax: (901) 459-3373

The provider's authorized official is Vickie D Long .
The authorized official title is Owner and has the following contact phone number (901) 440-6045.

The enumeration date for this NPI number is 1/23/2012 and was last updated on 3/11/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WG0600X	Registered Nurse	Gerontology	APN14184	TENNESSEE	No
2	163WP0808X	Registered Nurse	Psychiatric/Mental Health	APN14184	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1527059	MEDICAID	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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