Provider Demographics
NPI:1811614837
Name:LANG, MARIAH BROOKE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:BROOKE
Last Name:LANG
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:BROOKE
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1789 COURTNEY AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4046
Mailing Address - Country:US
Mailing Address - Phone:606-407-0646
Mailing Address - Fax:
Practice Address - Street 1:1789 COURTNEY AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4046
Practice Address - Country:US
Practice Address - Phone:606-407-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily