Provider Demographics
NPI:1699929687
Name:LANGSTON, ANITA KELSO (APRN)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:KELSO
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:JO
Other - Last Name:LANGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2714 UNION AVENUE EXT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4436
Mailing Address - Country:US
Mailing Address - Phone:901-725-0872
Mailing Address - Fax:901-278-6934
Practice Address - Street 1:2714 UNION AVENUE EXT
Practice Address - Street 2:SUITE 150
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4436
Practice Address - Country:US
Practice Address - Phone:901-725-0872
Practice Address - Fax:901-278-6934
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012949363LA2200X, 364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3345599OtherPTAN