Provider Demographics
NPI:1962480988
Name:LANGFORD, KELLI BROWDER (CRNA)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:BROWDER
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 22926
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-2926
Mailing Address - Country:US
Mailing Address - Phone:713-400-2990
Mailing Address - Fax:713-400-2993
Practice Address - Street 1:1635 NORTH LOOP WEST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1593
Practice Address - Country:US
Practice Address - Phone:713-400-2990
Practice Address - Fax:713-400-2993
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658675367500000X
TXRN658675367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164636607Medicaid
TX8152UUOtherBLUE CROSS BLUE SHIELD
TXP00795475OtherMEDICARE RAILROAD
TX8152UUOtherBLUE CROSS BLUE SHIELD
TXTXB114375Medicare PIN
TX164636607Medicaid