Provider Demographics
NPI:1043996788
Name:HABERMEHL, ANGELA MEREDITH (CPNP-PC, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MEREDITH
Last Name:HABERMEHL
Suffix:
Gender:F
Credentials:CPNP-PC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1702 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1625
Mailing Address - Country:US
Mailing Address - Phone:816-377-2850
Mailing Address - Fax:
Practice Address - Street 1:9784 N ASH AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-9742
Practice Address - Country:US
Practice Address - Phone:816-207-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023025372363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics