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General NPI Number Information
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NPI Number | 1649793555
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Entity Type | Individual
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Provider Name | MATTHEW NEAL LANGFORD PMHNP
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Gender | Male
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 07/23/2017
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Provider Practice Location Address
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Address Line | 1200 S WILLOW AVE
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City | COOKEVILLE
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State | TN
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Zip | 38506-4157
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Country | US
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Telephone | 931-432-4123
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Fax | 931-432-4123
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Provider Business Mailing Address
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Address Line | 11 BATTLEFIELD RD
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City | COOKEVILLE
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State | TN
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Zip | 38506-5532
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Country | US
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Telephone | 931-284-2433
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Fax | 931-528-9738
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN0000023000
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License Number State | TN
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