Provider Demographics
NPI:1114954245
Name:KLINE, ANGELA MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELE
Last Name:KLINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8171 SHANNON GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8565
Mailing Address - Country:US
Mailing Address - Phone:614-733-0093
Mailing Address - Fax:
Practice Address - Street 1:3773 OLENTANGY RIVER RD
Practice Address - Street 2:EXECUTIVE HEALTH
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3425
Practice Address - Country:US
Practice Address - Phone:614-566-2493
Practice Address - Fax:614-566-2346
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001405363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S83182Medicare UPIN