Provider Demographics
NPI:1043937550
Name:LUNDY, ANGELA M (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:LUNDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-433-6625
Mailing Address - Fax:423-723-2669
Practice Address - Street 1:1242 W SHIPLEY FERRY RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-3323
Practice Address - Country:US
Practice Address - Phone:423-239-7300
Practice Address - Fax:423-239-7607
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA24183221363LF0000X
TN30436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily