Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP135775 | TX |
NPI | 1023521069 |
---|---|
Provider Name | Andrew Nathan Langford |
First Address | Fort Worth, TX 76104-7657 |
Second Address | Fort Worth, TX 76104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2017 |
Last Update Date | 17/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
803981 | RN LICENSE (01) | TX |
AP135775 | LICENSE (01) | TX |