Provider Demographics
NPI:1699198333
Name:LANGFORD, MISTY DAWN (APRN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2410
Mailing Address - Country:US
Mailing Address - Phone:816-271-7011
Mailing Address - Fax:816-271-0421
Practice Address - Street 1:1115 N BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-271-7077
Practice Address - Fax:816-271-0421
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1699198333Medicaid
MO701000238OtherMISSOURI MEDICARE