Provider Demographics
NPI:1689826091
Name:LANGHURST, TRACY LYNNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNNE
Last Name:LANGHURST
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 CENTRAL AVE # 119
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3606
Mailing Address - Country:US
Mailing Address - Phone:319-310-2234
Mailing Address - Fax:
Practice Address - Street 1:1733 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3601
Practice Address - Country:US
Practice Address - Phone:707-839-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000853363A00000X
CA53046363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant