Basic Information
| Provider Information | |||||||||
| NPI: | 1063964971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANGLEY | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 DITNEY RD | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424318944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595397014 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1023 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424451253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702545840 | ||||||||
| FaxNumber: | 2702545353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2016 | ||||||||
| LastUpdateDate: | 04/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 3010607 | KY | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 363L00000X | 3010607 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 3010607 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.