Provider Demographics
NPI:1063990273
Name:LANGFELDER, JAYLA BREANN
Entity type:Individual
Prefix:
First Name:JAYLA
Middle Name:BREANN
Last Name:LANGFELDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JAYLA
Other - Middle Name:BREANN
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2312
Mailing Address - Country:US
Mailing Address - Phone:217-544-3143
Mailing Address - Fax:217-544-4436
Practice Address - Street 1:1020 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2312
Practice Address - Country:US
Practice Address - Phone:217-544-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.030975363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health