Provider Demographics
NPI:1740736628
Name:LANGHAM, JACI (RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JACI
Middle Name:
Last Name:LANGHAM
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 MATLOCK RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5660
Mailing Address - Country:US
Mailing Address - Phone:817-472-8180
Mailing Address - Fax:817-472-7910
Practice Address - Street 1:4519 MATLOCK RD
Practice Address - Street 2:SUITE 135
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5660
Practice Address - Country:US
Practice Address - Phone:817-472-8180
Practice Address - Fax:817-472-7910
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770526163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator