Healthcare Provider Details

I. General information

NPI: 1518420439
Provider Name (Legal Business Name): ANDREA MICHELLE LANGSTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 N 4TH ST
WILLS POINT TX
75169-1616
US

IV. Provider business mailing address

3360 COUNTY ROAD 4301
GREENVILLE TX
75401-1779
US

V. Phone/Fax

Practice location:
  • Phone: 903-873-3330
  • Fax:
Mailing address:
  • Phone: 903-461-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141068
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: