1871909176 NPI number — ALEXIS VICTORIA-KRESKE LANGDON M.A., LPA, HSP-PA

Table of content: ALEXIS VICTORIA-KRESKE LANGDON M.A., LPA, HSP-PA (NPI 1871909176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871909176 NPI number — ALEXIS VICTORIA-KRESKE LANGDON M.A., LPA, HSP-PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGDON
Provider First Name:
ALEXIS
Provider Middle Name:
VICTORIA-KRESKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPA, HSP-PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRESKE
Provider Other First Name:
ALEXIS
Provider Other Middle Name:
VICTORIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871909176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1772
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKYLAND
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28776-1772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-256-3266
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 MCDOWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-412-3144
Provider Business Practice Location Address Fax Number:
828-782-3002
Provider Enumeration Date:
07/08/2014

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: 103T00000X , with the licence number:  4325 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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