Provider Demographics
NPI:1578131330
Name:LANGSTON KIRKLAND, JILLEEN
Entity Type:Individual
Prefix:
First Name:JILLEEN
Middle Name:
Last Name:LANGSTON KIRKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 S 200 E
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3436
Mailing Address - Country:US
Mailing Address - Phone:602-295-6757
Mailing Address - Fax:
Practice Address - Street 1:305 N 500 W
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4520
Practice Address - Country:US
Practice Address - Phone:435-669-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8789888-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily