Provider Demographics
NPI:1770885345
Name:LANG, ANGELA J (ARNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:LANG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PORTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1230
Mailing Address - Country:US
Mailing Address - Phone:606-365-9181
Mailing Address - Fax:606-365-9183
Practice Address - Street 1:126 PORTMAN AVE
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1230
Practice Address - Country:US
Practice Address - Phone:606-365-9181
Practice Address - Fax:606-365-9183
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100165890Medicaid
KYK014852Medicare PIN