Provider Demographics
NPI:1528212164
Name:HOUSEWORTH, ANGELA MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:HOUSEWORTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1697 MONMOUTH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2664
Mailing Address - Country:US
Mailing Address - Phone:859-292-0123
Mailing Address - Fax:859-292-0131
Practice Address - Street 1:1697 MONMOUTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2664
Practice Address - Country:US
Practice Address - Phone:859-292-0123
Practice Address - Fax:859-292-0131
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5824P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100079820Medicaid
1528212164OtherNPI
1528212164OtherNPI
KY7100079820Medicaid