Provider Demographics
NPI:1316592553
Name:WHITLEY, ANGELA MOORE (APRN, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MOORE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:APRN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4518 TED TROUT DR STE A
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-6642
Mailing Address - Country:US
Mailing Address - Phone:936-674-5277
Mailing Address - Fax:
Practice Address - Street 1:4518 TED TROUT DR STE A
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-6642
Practice Address - Country:US
Practice Address - Phone:936-674-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily