Provider Demographics
NPI:1528410024
Name:WHALEN, ANGELA (APN FNP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WHALEN
Suffix:
Gender:F
Credentials:APN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6799 GREAT OAKS RD
Mailing Address - Street 2:STE 250
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2584
Mailing Address - Country:US
Mailing Address - Phone:901-261-0707
Mailing Address - Fax:
Practice Address - Street 1:368 SKATING RINK RD
Practice Address - Street 2:
Practice Address - City:RED BANKS
Practice Address - State:MS
Practice Address - Zip Code:38661-9767
Practice Address - Country:US
Practice Address - Phone:901-489-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily