Provider Demographics
NPI:1801773957
Name:LONGMAN, LIBBY NOELLE (PA)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:NOELLE
Last Name:LONGMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:NOELLE
Other - Last Name:HELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:117 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2512
Mailing Address - Country:US
Mailing Address - Phone:469-999-1148
Mailing Address - Fax:
Practice Address - Street 1:7700 FISH POND RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1031
Practice Address - Country:US
Practice Address - Phone:254-761-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA19269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant