Provider Demographics
NPI:1992219174
Name:LANG, NOELLE ALLISON (APRN)
Entity Type:Individual
Prefix:MS
First Name:NOELLE
Middle Name:ALLISON
Last Name:LANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:NOELLE
Other - Middle Name:
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4914
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:11901 STANDIFORD PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229
Practice Address - Country:US
Practice Address - Phone:502-969-0526
Practice Address - Fax:502-969-0565
Is Sole Proprietor?:No
Enumeration Date:2017-11-26
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011739207LP2900X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100542710Medicaid