MEDICARE: MS. KIMBERLY S LANGDON N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71000765A	IN
2	363LF0000X	Family Nurse Practitioner	28110187A	IN

General Provider Information

NPI Number	:	1588616726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY S LANGDON N.P.

Provider Business Mailing Address
First Line	:	907 E MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3625
Country	:	US
Telephone Number	:	317-262-0950
Fax Number	:	317-267-0244

Provider Business Practice Location Address
First Line	:	907 E MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3625
Country	:	US
Telephone Number	:	317-262-0950
Fax Number	:	317-267-0244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	11/08/2010

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