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NPI Code Detail

MEDICARE: ANITA KELSO LANGSTON APRN

MEDICARE: ANITA KELSO LANGSTON APRN
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
1363LA2200XAdult Health Nurse PractitionerAPN0000012949TN
2364SC0200XCritical Care Medicine Clinical Nurse SpecialistAPN0000012949TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13345599OTHERTNPTAN

General Provider Information

NPI Number : 1699929687
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITA KELSO LANGSTON APRN
Provider Business Mailing Address
First Line : 2714 UNION AVENUE EXT
Second Line : SUITE 150
City : MEMPHIS
State : TN
Zip : 38112-4436
Country : US
Telephone Number : 901-725-0872
Fax Number : 901-278-6934
Provider Business Practice Location Address
First Line : 2714 UNION AVENUE EXT
Second Line : SUITE 150
City : MEMPHIS
State : TN
Zip : 38112-4436
Country : US
Telephone Number : 901-725-0872
Fax Number : 901-278-6934
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2008
Last Update Date : 12/07/2011

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