Provider Demographics
NPI:1518305812
Name:JENNINGS, ANGEL
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:
Last Name:JENNINGS
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 1:320 BROOKES DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2736
Mailing Address - Country:US
Mailing Address - Phone:314-731-7770
Mailing Address - Fax:
Practice Address - Street 1:320 BROOKES DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2736
Practice Address - Country:US
Practice Address - Phone:314-731-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2018-08-31
Deactivation Date:2017-04-13
Deactivation Code:
Reactivation Date:2018-08-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant