Provider Demographics
NPI:1467638528
Name:LANGSTON, JESSICA TERESA (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:TERESA
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 10597
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1597
Mailing Address - Country:US
Mailing Address - Phone:512-485-5878
Mailing Address - Fax:512-420-0397
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:1300
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-244-2273
Practice Address - Fax:512-671-7883
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2014-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant