Provider Demographics
NPI:1366561417
Name:LANGDON, KRISTAN (NP)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:
Last Name:LANGDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 JESSE HILL DR SE BOX 26019
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-6019
Mailing Address - Country:US
Mailing Address - Phone:404-616-1000
Mailing Address - Fax:
Practice Address - Street 1:9998 N DRANSFELDT RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4013
Practice Address - Country:US
Practice Address - Phone:303-841-5266
Practice Address - Fax:303-841-7590
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-174352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORN-174352OtherCOLORADO BOARD OF NURSING
GARN170212OtherLICENCE