LONGEVITY MEDICAL LLC (NPI# 1467723486) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467723486 |
| Entity Type | Organization |
| Organization Name | LONGEVITY MEDICAL LLC |
| Practice Address |
1355 B Lynnfield Rd, Ste 245 Memphis TN 38119-5801 |
| Mailing Address |
Po Box 4355 Cordova TN 38088-4355 |
| Practice Telephone | 9016841977 |
| Practice Fax Number | 9016831182 |
| Mailing Telephone | 9016841977 |
| Mailing Fax Number | 9016831182 |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2020-01-09 |
| Authorized Official Name | VICKIE D LONG (OWNER) |
| Authorized Official Telephone | 9016841977 |
| Authorized Official Credential | DNP,FNP-BC,PMHNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WG0600X |
Registered Nurse Specialization: Gerontology |
APN14184 | TN | Nursing Service Providers |
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
APN14184 | TN | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 1527059 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1669 Stable Run Dr, Cordova, TN 380167624 | 9017366722 | 8888735467 |
| 1250 Farrow Rd, Memphis, TN 381167116 | 9013327290 | 9013324176 |
| 1076 Chambliss Rd, Memphis, TN 381166381 | 9013968470 | 9013980271 |
| 9684 Goodman Rd, Olive Branch, MS 386541726 | 6628957616 | 6628953501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386902609 | Longevity Medical LLC | Chiropractor | 572 Broadway, Long Branch, NJ 07740-5907 | 2012-04-24 |
| 1972779486 | Longevity Medical LLC | Specialist | 540 Bordentown Avenue, Suite 4200, South Amboy, NJ 08879-0157 | 2008-05-05 |
| Street Address |
1355 B LYNNFIELD RD, STE 245 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38119-5801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417469628 | Jojuan Fullwiley | Behavioral Analyst | 6685 Quince Rd Ste 116, Memphis, TN 38119 | 2017-10-27 |
| 1336675297 | Jill Budynas Depriest | Counselor | 5583 Murray Ave Ste 203, Memphis, TN 38119 | 2017-05-11 |
| 1396279220 | Glen Matthew Stamps Jr. | Counselor | 5583 Murray Ave Ste 207, Memphis, TN 38119 | 2017-04-18 |
| 1598117442 | Hazel Aberdeen | Chiropractor | 1911 Memphis Tennessee, Memphis, TN 38119 | 2016-07-04 |
| 1831569060 | E-c-t Non Emergency Medical Transport | Non-emergency Medical Transport (VAN) | 6869 Woodlake Dr, Memphis, TN 38119 | 2015-09-30 |
| 1053781617 | Astrid Roman | Dietitian, Registered | 8020 Hillside Cv, Memphis, MS 38119 | 2015-09-25 |
| 1467857664 | Allan Jacob Katz | Counselor | 5668 Rex Rd, Suite 104, Memphis, TN 38119 | 2014-10-30 |
| 1962836015 | Judy Ann Harrick | Acupuncturist | 5575 Poplar Ave., #702, Memphis, TN 38119 | 2013-08-26 |
| 1366791949 | Jennifer Denyes Bidelman | Audiologist | 5625 Poplar Avenue, Memphis, TN 38119 | 2012-08-29 |
| 1578833620 | Elizabeth Mary Dion-douglass | Pharmacist | 2891 Kirby Parkway, Memphis, TN 38119 | 2012-01-06 |
| Find all providers in zip 38119 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053308130 | Sarah Mynatt | Registered Nurse | 920 Madison Ave, Suite 520, Memphis, TN 38163-0001 | 2005-10-04 |
| 1265030175 | Clifton Mcrae Allred | Registered Nurse | 6005 Park Ave Ste 630b, Memphis, TN 38119-5226 | 2020-10-13 |
| 1992346498 | Emily Phipps | Registered Nurse | 951 Court Ave, Memphis, TN 38103-2813 | 2019-10-05 |
| 1043752793 | Camillia Haddix | Registered Nurse | 6005 Park Ave Ste 630b, Memphis, TN 38119-5226 | 2016-11-12 |
| 1003075268 | Deborah Gerise Kartheiser | Registered Nurse | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2008-06-03 |
| 1134328867 | Robin Kay Moyers | Registered Nurse | 877 Jefferson Ave, Memphis, TN 38103-2807 | 2007-07-12 |
| 1386777290 | Nan Lynn Thoda | Registered Nurse | 2150 Whitney Ave, Memphis, TN 38127-6662 | 2007-03-13 |
| 1679643019 | Karen Cecilia Hendry | Registered Nurse | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669958708 | Paulinus Nwaija | Registered Nurse | 730 Huntington Pkwy, Nashville, TN 37211-5919 | 2018-07-12 |
| 1922592229 | Samantha Thompson | Registered Nurse | 3308 Blaze Dr, Murfreesboro, TN 37128-3878 | 2018-06-20 |
| 1588165112 | Cara Victoria Jill Mcmahan | Registered Nurse | 310 W 3rd N Street, Morristown, TN 37814 | 2018-02-28 |
| 1891295481 | Gregory T Tipton | Registered Nurse | 302 Sunset Dr Ste 105, Johnson City, TN 37604-2408 | 2018-02-20 |
| 1699294595 | Charlene L. Donovan | Registered Nurse | 1283 Murfreesboro Pike Ste 500, Nashville, TN 37217-2421 | 2017-09-12 |
| 1588181861 | Kayla Ashley West | Registered Nurse | 223 Madison St Ste 103, Madison, TN 37115-3660 | 2017-08-27 |
| 1629509369 | Sommer Wright | Registered Nurse | 1128 Radmoor Ln, Chattanooga, TN 37421-4048 | 2017-03-24 |
| 1053795518 | Charles Olsen | Registered Nurse | 307 Devonia St, Harriman, TN 37748-2008 | 2015-07-15 |
| 1518238708 | Barbara J Howard | Registered Nurse | 736 Jessica Taylor Dr, Madison, TN 37115-5580 | 2012-01-19 |
| 1235449398 | Onochie Nnodu | Registered Nurse | 2350 Mccampbell Wells Way, Knoxville, TN 37924-3128 | 2010-10-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.