Provider Demographics
NPI:1225578685
Name:BUCKHALL, ANGELA (CBD,CBE,SFN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:BUCKHALL
Suffix:
Gender:F
Credentials:CBD,CBE,SFN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 KNAEBEL LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-4344
Mailing Address - Country:US
Mailing Address - Phone:225-921-2730
Mailing Address - Fax:573-634-2188
Practice Address - Street 1:308 KNAEBEL LN
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-4344
Practice Address - Country:US
Practice Address - Phone:225-921-2730
Practice Address - Fax:573-634-2188
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X, 171400000X
MO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No175M00000XOther Service ProvidersMidwife, LayGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach