Healthcare Provider Details

I. General information

NPI: 1083284285
Provider Name (Legal Business Name): OLIVIA LANGFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA LOONEY

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

IV. Provider business mailing address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

V. Phone/Fax

Practice location:
  • Phone: 903-597-0351
  • Fax:
Mailing address:
  • Phone: 731-336-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number222061
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number30723
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number1159319
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: