Provider Demographics
NPI:1275245516
Name:BARNETTE, ANGELA GRACE (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:GRACE
Last Name:BARNETTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-1132
Mailing Address - Country:US
Mailing Address - Phone:304-364-1063
Mailing Address - Fax:
Practice Address - Street 1:64 STATE ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1132
Practice Address - Country:US
Practice Address - Phone:304-364-1063
Practice Address - Fax:304-364-8637
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39698164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse