Healthcare Provider Details

I. General information

NPI: 1073405635
Provider Name (Legal Business Name): ABBY LANGTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13460 N 94TH DR STE J1
PEORIA AZ
85381-4264
US

IV. Provider business mailing address

13460 N 94TH DR STE J1
PEORIA AZ
85381-4264
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-8816
  • Fax: 623-298-0168
Mailing address:
  • Phone: 623-876-8816
  • Fax: 623-298-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11164
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: