Provider Demographics
NPI:1033765730
Name:OIGBOKIE, ANGELA
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:OIGBOKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 STRAWBERRY POINTE CV
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6619
Mailing Address - Country:US
Mailing Address - Phone:901-569-0208
Mailing Address - Fax:
Practice Address - Street 1:5833 STRAWBERRY POINTE CV
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6619
Practice Address - Country:US
Practice Address - Phone:901-569-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-18
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN000026111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner