Healthcare Provider Details

I. General information

NPI: 1972855724
Provider Name (Legal Business Name): MARY BETH LANGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 STAGE RD STE 106
BARTLETT TN
38133-8955
US

IV. Provider business mailing address

850 COLD CREEK CV
COLLIERVILLE TN
38017-4972
US

V. Phone/Fax

Practice location:
  • Phone: 901-779-8051
  • Fax:
Mailing address:
  • Phone: 731-358-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17057
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: