Provider Demographics
NPI:1700299047
Name:LANGLEY, BECKY (NNP-BC)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:GATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-510-1113
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-525-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124480363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977042OtherTRICARE
TX8643NWOtherBCBS
TX359405301Medicaid
TXP01681637OtherRAIL ROAD MEDICARE
TX8643NWOtherBCBS