Provider Demographics
NPI:1437789609
Name:MCNUTT, ANGELA KAY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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 169
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:AL
Mailing Address - Zip Code:35580-0169
Mailing Address - Country:US
Mailing Address - Phone:205-686-5113
Mailing Address - Fax:205-265-2994
Practice Address - Street 1:110 LEGION RD STE B
Practice Address - Street 2:
Practice Address - City:DOUBLE SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:35553-2365
Practice Address - Country:US
Practice Address - Phone:256-841-4858
Practice Address - Fax:205-489-2417
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-50513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily