MEDICARE: KRISTINA LANGLEY FNP-C

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	363LF0000X	Family Nurse Practitioner	107097	WV
2	363LF0000X	Family Nurse Practitioner	SP022301	PA
3	363LF0000X	Family Nurse Practitioner	APRN.CNP.0027331	OH

General Provider Information

NPI Number	:	1992319594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA LANGLEY FNP-C

Provider Business Mailing Address
First Line	:	48462 BELL SCHOOL RD STE A
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9625
Country	:	US
Telephone Number	:	724-773-3404
Fax Number	:	724-770-7939

Provider Business Practice Location Address
First Line	:	48462 BELL SCHOOL RD STE A
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9625
Country	:	US
Telephone Number	:	724-773-3404
Fax Number	:	724-770-7939

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

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	03/17/2021

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