Provider Demographics
NPI:1497048169
Name:LANGHOUT, DEANNA STAIRES (MSN,CRNP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:STAIRES
Last Name:LANGHOUT
Suffix:
Gender:F
Credentials:MSN,CRNP
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:LYNN
Other - Last Name:STAIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-114109363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05777014Medicaid
AL129449Medicaid
AL129452Medicaid
AL051118095OtherBCBS
AL129450Medicaid
AL129453Medicaid
AL051118093OtherBCBS
AL051118096OtherBCBS
AL051118092OtherBCBS
AL051118094OtherBCBS
AL051118097OtherBCBS
AL129454Medicaid
ALZ21076OtherVIVA
AL129451Medicaid
AL129453Medicaid