Provider Demographics
NPI:1295204618
Name:KOONS, ANGELA WALSH (APRN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:WALSH
Last Name:KOONS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 N EMERSON ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1450
Mailing Address - Country:US
Mailing Address - Phone:720-358-2862
Mailing Address - Fax:833-358-2800
Practice Address - Street 1:1554 N EMERSON ST UNIT 5
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1450
Practice Address - Country:US
Practice Address - Phone:720-358-2862
Practice Address - Fax:833-358-2800
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139684363LF0000X
COC-APN.0100812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily