Provider Demographics
NPI:1790399236
Name:LANGFORD, KIMBERLY ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
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 1:147 OLD HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:EUBANK
Mailing Address - State:KY
Mailing Address - Zip Code:42567-7843
Mailing Address - Country:US
Mailing Address - Phone:606-379-0655
Mailing Address - Fax:
Practice Address - Street 1:166 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2430
Practice Address - Country:US
Practice Address - Phone:606-348-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015103363LF0000X
KY57107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily