Provider Demographics
NPI:1205726437
Name:LANGFORD, KIMBERLEE
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2196 S CHESAPEAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7480
Mailing Address - Country:US
Mailing Address - Phone:208-918-3715
Mailing Address - Fax:
Practice Address - Street 1:2196 S CHESAPEAKE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7480
Practice Address - Country:US
Practice Address - Phone:208-918-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID27657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse