1518152552 NPI number — MS. ANGELA KAY ANDINO RNC,WHCNP

Table of content: MS. ANGELA KAY ANDINO RNC,WHCNP (NPI 1518152552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518152552 NPI number — MS. ANGELA KAY ANDINO RNC,WHCNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDINO
Provider First Name:
ANGELA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNC,WHCNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHILLIPS
Provider Other First Name:
ANGELA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RNC,WHCNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518152552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7765 KELLY LYNN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATAUGA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76148-2434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-244-6133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75840-4313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-731-5261
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2007

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: 363LW0102X , with the licence number:  570878 , 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)





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