Provider Demographics
NPI:1376006585
Name:BOHON, ANGELA SUSAN
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUSAN
Last Name:BOHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 CHENAL PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3707
Mailing Address - Country:US
Mailing Address - Phone:501-221-1160
Mailing Address - Fax:501-221-1161
Practice Address - Street 1:11600 CHENAL PKWY STE 5
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3707
Practice Address - Country:US
Practice Address - Phone:501-221-1160
Practice Address - Fax:501-221-1161
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV93458163WC0200X
WV103786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine