MEDICARE: KERRI M. LANGEVIN MSN, APRN, PNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	000883	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427235373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI M. LANGEVIN MSN, APRN, PNP-BC

Provider Business Mailing Address
First Line	:	1 FOREST PARK DR
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1487
Country	:	US
Telephone Number	:	860-677-1112
Fax Number	:	860-674-9442

Provider Business Practice Location Address
First Line	:	1 FOREST PARK DR
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1487
Country	:	US
Telephone Number	:	860-677-1112
Fax Number	:	860-674-9442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/08/2016

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