Provider Demographics
NPI:1346036514
Name:LANGSTON, JAMIE A (AGNP-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:A
Last Name:LANGSTON
Suffix:
Gender:
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLACK JACK LN
Mailing Address - Street 2:
Mailing Address - City:COPPER CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:75077-8516
Mailing Address - Country:US
Mailing Address - Phone:817-939-3204
Mailing Address - Fax:
Practice Address - Street 1:800 PARKER SQ STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7434
Practice Address - Country:US
Practice Address - Phone:469-470-0726
Practice Address - Fax:469-470-0726
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1195200207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine