Mary Jessica Langston, MS, ATC, LAT

Key facts

NPI

1154795219

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

AL3372 (FL)

Practice address

1040 Gulf Breeze Pkwy Ste 101
Gulf Breeze, FL 32561-7808

Phone

(850) 598-7456

NPI assigned

Nov 30, 2015

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Science

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 30, 2015.

{
    "created_epoch": "1448841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448841600000",
    "number": "1154795219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 GULF BREEZE PKWY STE 101",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325617808",
            "telephone_number": "850-598-7456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 GULF BREEZE PKWY STE 101",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325617808",
            "telephone_number": "850-598-7456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANGSTON",
        "first_name": "MARY",
        "middle_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "MS, ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-30",
        "last_updated": "2015-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL3372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Thomas Lampone, M.D.
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• Eric A Lane, ARNP
• Kamarie Lee Larson, LCSW
• Nicole Latham
• Quintin Orville Law, MD
• Gregory Edmund Lebleu I, MD
• Lisa D. Ledkins, LMT

All providers in Gulf Breeze, FL · Athletic Trainer in Florida