Provider Demographics
NPI:1588616726
Name:LANGDON, KIMBERLY S (NP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:S
Last Name:LANGDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3625
Mailing Address - Country:US
Mailing Address - Phone:317-262-0950
Mailing Address - Fax:317-267-0244
Practice Address - Street 1:907 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3625
Practice Address - Country:US
Practice Address - Phone:317-262-0950
Practice Address - Fax:317-267-0244
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000765A363LF0000X
IN28110187A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP12373Medicare UPIN
IN237490DMedicare PIN