MEDICARE: KIERA C LANGSTON

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	374J00000X	Doula

General Provider Information

NPI Number	:	1932670411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERA C LANGSTON

Provider Business Mailing Address
First Line	:	20207 INDIAN ROSEWOOD DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3486
Country	:	US
Telephone Number	:	813-614-5765
Fax Number	:

Provider Business Practice Location Address
First Line	:	20207 INDIAN ROSEWOOD DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3486
Country	:	US
Telephone Number	:	813-614-5765
Fax Number	:

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

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	12/10/2018

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Directions to “ KIERA C LANGSTON ” Practice Location

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