Provider Demographics
NPI:1427038686
Name:NEIGHBORS, ANGELA SUE (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUE
Last Name:NEIGHBORS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:SUE
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 OLD ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3730
Mailing Address - Country:US
Mailing Address - Phone:573-336-5100
Mailing Address - Fax:
Practice Address - Street 1:608 OLD ROUTE 66
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-3730
Practice Address - Country:US
Practice Address - Phone:573-336-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118093363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429355118Medicaid
MO824335005Medicare PIN
MO824333213Medicare PIN
S48688Medicare UPIN
MO429355118Medicaid