Provider Demographics
NPI:1801468772
Name:LANGDON, HEATHER LEEANN
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEEANN
Last Name:LANGDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WINDWARD LOOP
Mailing Address - Street 2:
Mailing Address - City:OHATCHEE
Mailing Address - State:AL
Mailing Address - Zip Code:36271-2800
Mailing Address - Country:US
Mailing Address - Phone:256-485-5344
Mailing Address - Fax:
Practice Address - Street 1:119 STEPHEN J WHITE MEM BLVD
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160
Practice Address - Country:US
Practice Address - Phone:256-268-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-076049363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9721OtherRX