Provider Demographics
NPI:1518552926
Name:RICHMOND, ANGELA (APRN-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 NORTHSIDE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-2032
Mailing Address - Country:US
Mailing Address - Phone:681-207-7105
Mailing Address - Fax:
Practice Address - Street 1:830 NORTHSIDE DR STE 107
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-2032
Practice Address - Country:US
Practice Address - Phone:681-207-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV108654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily