Provider Demographics
NPI:1225688518
Name:SPESARD LANGFIELD, NICOLE LYNN (PMHNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:SPESARD LANGFIELD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18230 E SILVER CREEK AVE BLDG 392
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9501
Mailing Address - Country:US
Mailing Address - Phone:750-847-6451
Mailing Address - Fax:
Practice Address - Street 1:18230 E SILVER CREEK AVE BLDG 392
Practice Address - Street 2:
Practice Address - City:BUCKLEY AFB
Practice Address - State:CO
Practice Address - Zip Code:80011-9501
Practice Address - Country:US
Practice Address - Phone:207-847-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61086638363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health