Provider Demographics
NPI:1891160164
Name:LANG, JENNIFER (APN, CNM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-1068
Mailing Address - Country:US
Mailing Address - Phone:573-471-0330
Mailing Address - Fax:573-481-5019
Practice Address - Street 1:1723 BROADWAY ST STE 315
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4556
Practice Address - Country:US
Practice Address - Phone:573-388-4846
Practice Address - Fax:573-388-7635
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20788367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1891160164Medicaid