Provider Demographics
NPI:1508620972
Name:MCCUDDY, ANGELA DAWN
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:MCCUDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:TICKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4320 VFW DR APT 36
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2143
Mailing Address - Country:US
Mailing Address - Phone:405-937-6435
Mailing Address - Fax:
Practice Address - Street 1:4320 VFW DR APT 36
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-2143
Practice Address - Country:US
Practice Address - Phone:405-937-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty