Provider Demographics
NPI:1306191036
Name:KEARBEY, ANGELA KIMBERLY (PLPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KIMBERLY
Last Name:KEARBEY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 894
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:MO
Mailing Address - Zip Code:63965-0894
Mailing Address - Country:US
Mailing Address - Phone:573-323-0411
Mailing Address - Fax:
Practice Address - Street 1:402 ELSIE ST.
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:MO
Practice Address - Zip Code:63965
Practice Address - Country:US
Practice Address - Phone:573-323-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011031452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional