Provider Demographics
NPI:1356585244
Name:LANGSTON, SANDRA S (CFNP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:S
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:CFNP
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Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:CARDIOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5678
Mailing Address - Fax:601-984-5638
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIVISION OF CARDIOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4505
Practice Address - Country:US
Practice Address - Phone:601-984-4241
Practice Address - Fax:601-815-6465
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2014-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MSR823654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09629565Medicaid
MS09629565Medicaid
MS30250I7215Medicare PIN
MSP01196926Medicare PIN