Provider Demographics
NPI:1427235373
Name:LANGEVIN, KERRI M (MSN, APRN, PNP-BC)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:M
Last Name:LANGEVIN
Suffix:
Gender:F
Credentials:MSN, APRN, PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1487
Mailing Address - Country:US
Mailing Address - Phone:860-677-1112
Mailing Address - Fax:860-674-9442
Practice Address - Street 1:1 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1487
Practice Address - Country:US
Practice Address - Phone:860-677-1112
Practice Address - Fax:860-674-9442
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000883363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004150108Medicaid