Healthcare Provider Details

I. General information

NPI: 1669387601
Provider Name (Legal Business Name): ALEXANDER SCOTT LANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E WASHINGTON AVE
JONESBORO AR
72401-3111
US

IV. Provider business mailing address

4216 LYNX LN
JONESBORO AR
72405-0658
US

V. Phone/Fax

Practice location:
  • Phone: 870-207-4100
  • Fax:
Mailing address:
  • Phone: 817-600-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1063956
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: