1386686459 NPI number — CARRIE LANGSTON JONES M.D.

Table of content: CARRIE LANGSTON JONES M.D. (NPI 1386686459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386686459 NPI number — CARRIE LANGSTON JONES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
CARRIE
Provider Middle Name:
LANGSTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386686459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99371
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76199-0371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-885-1855
Provider Business Mailing Address Fax Number:
682-885-7347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 HIGHWAY 377 N STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARGYLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76226-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-898-1477
Provider Business Practice Location Address Fax Number:
940-382-4091
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  M0119 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 178667501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".