Provider Demographics
NPI:1134510803
Name:HUNT, ANGIE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:MARIE
Last Name:HUNT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANGIE
Other - Middle Name:MARIE
Other - Last Name:BAUMERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822
Mailing Address - Country:US
Mailing Address - Phone:308-872-2486
Mailing Address - Fax:308-872-2027
Practice Address - Street 1:145 MEMORIAL DR.
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-0690
Practice Address - Country:US
Practice Address - Phone:308-872-2486
Practice Address - Fax:308-872-2027
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1895363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical