Provider Demographics
NPI:1104199215
Name:CLATER, ANGELA MITCHELL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MITCHELL
Last Name:CLATER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:140 WHITTINGTON PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4930
Mailing Address - Country:US
Mailing Address - Phone:502-327-9100
Mailing Address - Fax:502-742-3767
Practice Address - Street 1:140 WHITTINGTON PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4930
Practice Address - Country:US
Practice Address - Phone:502-327-9100
Practice Address - Fax:502-742-3767
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007356363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health