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NPI Code Detail

MEDICARE: MRS. HEATHER S LANGE APRN

MEDICARE: MRS. HEATHER S LANGE 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
1363L00000XNurse Practitioner28160594AIN
2363L00000XNurse Practitioner3004811KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2143319OTHERKYSIHO - WS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000000798249OTHERKYANTHEM - WS
550045366OTHERKYPASSPORT - WS

General Provider Information

NPI Number : 1861435521
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEATHER S LANGE APRN
Provider Business Mailing Address
First Line : 12201 BLUEGRASS PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2361
Country : US
Telephone Number : 502-568-7366
Fax Number : 502-568-7114
Provider Business Practice Location Address
First Line : 2100 MILLVALE RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-1604
Country : US
Telephone Number : 502-451-0990
Fax Number : 502-459-1018
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 05/18/2015

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